Dear Dr. Gott: I have a disputed claim with my local hospital and am becoming agitated about it. In 2005, I had a needle biopsy, and a clip was inserted in one breast. Then, in 2007, I was sent by my doctor for a routine mammogram. His requisition specifically called for a “routine screening.” The hospital billed the service as diagnostic because of the clip. My insurance company will pay for one free preventive screening mammogram each year. However, diagnostic services aren’t covered, and I have a $36.42 charge that insurance won’t pay.
As if this weren’t enough, the radiologist billed for a diagnostic service, and I have a $65.75 bill from them, which my insurance company again will not pay. So far, my “free” mammogram is costing $102.17. I feel this is discrimination. I asked my local hospital to send through a corrected bill and have been told resubmission would constitute fraud. Why? All I want is the correct information sent to my insurance company so it will pay the claim. I shouldn’t have to be out more than $100 because of an incorrect statement. What’s your take on this?
Dear Reader: Frankly, we all make mistakes at one time or another, and I cannot see anything wrong with your health facility issuing a copy of the original claim along with a letter explaining what occurred. There is no fraud involved, simply an error on the part of the insurance clerk.
The one issue I can see looming is the time involved. Most insurance companies have a limit as to how long following a service they will recognize a claim. Since this happened in 2007, it is my guess they will not open the case. I am not sure whether the hospital or radiologist can legally write off the charges. My guess is that they can’t. I side with you and believe you are doing everything you can to rectify an error that was not yours.
Dear Dr. Gott: I am a 63-year-old woman. For the past five years, I’ve had pain in my muscles and joints and suffer from chronic fatigue. It took me a long time to get a doctor to diagnose me because I have no health insurance. A rheumatologist finally diagnosed me with fibromyalgia, polymyalgia and chronic fatigue syndrome. I also have diabetes and a sciatic nerve leaning on two herniated discs.
Is there a specialist who can help with the chronic fatigue? My doctor says I just have to endure everything, but I do not accept that. I’m depressed and at my wits’ end.
Dear Reader: The pain and fatigue you are experiencing certainly appear to be affecting your quality of life, and I disagree that you simply have to endure the symptoms. While you may never be totally free of pain and fatigue, you can lead a productive life with the assistance of available resources, such as the physical-therapy department of your local hospital, a chronic-fatigue specialist in your area and perhaps even a pain clinic.
To provide related information, I am sending you a copy of my Health Report “Fibromyalgia.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a check or money order for $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.