Lisa Stein

paper crafter, quilter, crochet addict, book reader, golden retriever lover, vegan

June 9, 2009

Why did I need a Referral?

We have a lovely HMO health insurance plan. We’re pretty healthy, so it’s fine. We pay a co-pay for the doctor and we get cheaper prescriptions. As long as it’s a prescription for a drug invented before 1970.

Anyway, I’m having a leg issue. My right leg sometimes goes numb on me, and I’ve lost some mobility in my right foot. The doctor suggests some things for me to take/do to make sure it’s muscular, not neurological. I do them, and it’s muscular. Yeah! That means I get to go to physical therapy, rather than a neurologist. Perfect.

I wait a few days for the required referral to the physical therapy (“PT”) place. I finally get it and I’m allowed 24 visits. The day after the nurse calls me with the information, the PT place actually leaves me a message, to book an appointment. I thought they were on the ball (no pun intended) and was excited.

I called them today to find out the fees. I’m thinking it’s a co-pay situation. After giving her every single piece of identifying data about myself and my insurance she quickly says “Does tomorrow work for you"?” I say that I’d like to know how much this is going to cost me first, ha ha. She says she’ll have to get back to me.

She left me the following voice mail:

“Hi, it’s so and so from PT, I called your insurance company, and here are your benefits: You pay for PT until your deductible has been met. You have a $2,000 deductible of which you’ve met $49.47. After your deductible is met, your insurance pays 10%. Or… we can offer you our cash payment plan. That would be $100 for the first visit, and $80 each subsequent visit. Call me tomorrow to schedule your appointment.”

Really? You can “offer” me your cash plan? Do I sound like someone who can’t use a calculator? Because if I add up your offer, I’d be spending $1,940 (for suggested 24 visits). Why wouldn’t I just do that through insurance so at least I can meet my deductible? Oh, wait. As I type this I realize that those are “special cash” rates, so I’d probably meet my deductible sooner if I went with the insurance rates vs. the cash rates.

I needed to wait for a referral for this? Is that so that my health insurance company gets a kickback in case I happen to be stupid enough to pay for this?

So… if any of you out there are physical therapists, please drop me a line. I’d love to get some tips for fixing my legs with exercise. In the meantime, I’m walking on the treadmill, hoping regular exercise and hopefully some weight loss, will help my leg get back to normal.

Oh, and as an aside, our insurer is raising rates for our next year. By 34%.

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Posted In: Uncategorized · Tagged: health insurance, rant of the day

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