When life seems like a colonoscopy

As I bent over an examination table in preparation for a proctology exam, the doctor snapped a rubber glove on his hand and asked, “Are you the newspaper columnist?”

Many questions go through your mind at such a time, but there was only that seemed vitally important.

“Do you like what that guy writes?” I asked. I often think of that predicament as symbolic of our journey through life. We are constantly confronted by challenges that remind us how vulnerable we are and how little we know about the people whose lives intersect with our own.

For example, I received a letter from Blue Cross/Blue Shield notifying me that it would not pay a medical bill for a test ordered by my doctor.

Why?

Because Medicare had refused to pay the bill and if Medicare refuses to pay so does Blue Cross/Blue Shield, which is my supplemental insurance. That’s right, this is the insurance I pay for in case Medicare fails to pay for something. But Blue Cross/Blue Shield was now telling me that if Medicare isn’t going to pay, it sure the heck wasn’t going to fork over the money to the laboratory that had performed the test.

Why had Medicare refused to pay? “You have to call them,” I was told.

And I did.

The person who answered my call told me she did not know why Medicare had not paid the bill, but she could mail me a form to file an appeal. I would have to get some additional paperwork from my doctor, a urologist, and then send it all in.

Or, I could just call the laboratory and ask them to appeal Medicare’s refusal on my behalf.

I called the laboratory and spoke to someone in billing. Somehow, I was reminded of the day I bent over that examination table in the doctor’s office as he prepared to conduct a digital rectal examination.

I was asked for my name, my birth date, my address and a lot of other personal information by someone whose name I did not know. She sounded nice. Despite the HIPAA law, this is the sort of information we now share with strangers all the time. Only the privacy of the person answering the phones is protected.

In a very nice voice, the woman said, “I found your information. Medicare never pays for that test. Ever.”

But the doctor recommended the test. “Yes, doctors often recommend that test, but Medicare never pays for it. But we will appeal to your supplemental insurance company.”

They said they would not pay unless Medicare paid, I explained.

“Yes, they say that. But we always appeal and sometimes they pay something.”

The nice lady then told me not to worry because even if Blue Cross/Blue Shield fails to pay anything, the laboratory will automatically give me a 60 percent discount. I would not have to pay the full price for the lab test. That’s the full price as in the amount the laboratory had billed Medicare and later Blue Cross/Blue Shield.

I thought I heard the sound of a rubber glove being snapped over a hand.

Is there something wrong with a system where people charge 60 percent more than necessary in the hope that someone will pay the full price? Is there something wrong with a system where insurers don’t pay the cost of a laboratory service that is required to prevent a costly surgery that might not be necessary? Does anyone care?

My doctor told me I had nothing to worry about. “See you next year,” he said with a smile.

I moved on to the doctor who would give me a colonoscopy.

“Are you the columnist?” a nurse asked as my gurney was wheeled into the operating room.

Many questions crossed my mind, such as would Medicare pay for this procedure. But only one seemed vital at the time. Did the nurse like the columns that guy wrote?

IS THERE SOMETHING WRONG WITH A SYSTEM WHERE INSURERS DON’T PAY THE COST OF A LABORATORY SERVICE THAT IS REQUIRED TO PREVENT A COSTLY SURGERY THAT MIGHT NOT BE NECESSARY?