OK call me naive. I thought my healthcare provider was working for me. In all fairness, it usually does, but this past incident reminds me that they do not always.

I recently had a provider’s office call me back for a follow up - some photos. Pretty simple really - they had already done it once. Problem is, the insuror said the pictures were not sufficient to determine if they would approve the procedure. So the nurse called and asked me to come back. I asked who would pay for that. The other end of the line went quiet for a moment, the nurse clearly taken off guard by the question, but she quickly understood that it was a customer service issue and said that if the pictures weren’t good enough that they would not charge me to retake them. Satisfied, I went in.

At the front desk, the woman asked for the co-pay. I explained the situation and what the nurse had told me. I had distracted the lemming from its path and now it was left to wander, “I don’t know how to do that.” She looked around as if something on her desk might explain. She made to get up and go ask, then sat down. She looked around the desk again (what the hell was she looking for?). And then she had a spark of an idea. “I know what I’ll do. I’ll make it a follow up visit with no charge.” Worked for me.

Got the photos. Went home.

Then the bill for my co-pay arrived. And an EOB arrived. They charged my insurance $33 and wanted the $20 co-pay from me. I called the provider’s business office (part of a large medical center). They put it in for review.

I got another statement. They wanted $20.

I called my insuror. I explained to the lady on the other end of the line what had happened and that either my provider was a poor photographer or my insuror was unnessecarily driving up my expenses on the matter by asking for uneccesary procedures.

Here was the basic response.

Our contract with the provider is that they bill us, and we pay them. That agreement you made was a private side agreement. We have no control over that. They bill us, and we pay them.

So I asked, “Basically what you’re telling me is that I might get my co-pay back, but you’ve sent them the $33 and they are going to keep it?”

“Yes, sir. They bill us, and we pay them.”

I think I went over her head in my understanding of things with the next part. “So you’ve paid out $33 that was not supposed to be paid out, and I’m going to be underwritten with that as an expense when it comes time to renew and establish my rate for next year?”

“Um. That’s our agreement with them.”

It’s not the amount. It’s the principle of the thing. I got them to write off the co-pay. They kept my $33 paid by my insuror.

They bill us, and we pay them.

Thanks.