First, you were warned by the title - this is going to be a short tirade. For that, I apologize, but you do have the power to not read any further.
Second, you can thank me. It's a common blogging maxim that each blog post should contain a picture to make the post more appealing. I considered posting a picture of my beauty mark (aka scar) outlined with acupuncture needles, but decided to spare you the sight. You're welcome.
So, on with the tirade.
I received a statement of benefits yesterday from my insurance company in which they stated how much of my surgeon's bill they were paying. Now, I work for the State of Alaska and have good insurance; these types of things shouldn't be a problem. However, of the $20,718 on this billing, the insurance company said I was liable for $4,140. A message at the bottom, however, said "major medical benefits payable at 100% per plan provisions." Huh?
When I called the insurance company to find out what the deal was, I was told that the original surgery was covered completely, but that the individual procedures within the surgery were only covered at 50%. They consider this a multiple surgery situation. If I understand correctly, they'd pay 100% for the surgeon to cut open my shoulder, but only 50% for him to actually fix the two tendons and remove bone spurs.
Am I nuts for thinking this is nuts? Needless to say, I will be following up with both the surgeon's office and the insurance company. Luckily, I've saved all bills and previous benefits statements, so I should be able to go armed into this fight. I'm just disappointed and angry that I have to fight at all.
P.S. If you want to know what surgery I'm talking about, check out this post or click shoulder surgery in the topic cloud to the right for all related posts.