Don't Bullsh*t Me

This morning, Winning Run was pretty sore from last night's car accident. Honestly, we figured that would probably be the case. So, we'd made plans for her to get in to see the doctor just to be sure that her wrist was okay and there was no greater damage than cosmetic.

I went to walk Dylan and left her to make the calls to set up the appointment. During my walk, I get a call from Winning Run who was terribly upset because the doctor's office had told her that "auto accidents" aren't covered by insurance and that she'd have to pay out-of-pocket for any office visit.

"What?," I asked in disbelief.

"We'll have to pay for it. They said 'it's not covered.' Why are we paying so much if they won't cover an auto accident?," my wife said, fighting back tears.

"That's bullshit. If you fell down, they'd cover it. I don't understand how the cause of the injury makes any difference."

We ended our conversation and I headed back home. I was fuming. Seriously, was her doctor's office refusing treatment because she'd been in an auto accident? Were they just trying to distance themselves from the litigiousness that accompanies accidents? What the hell?

By the time, I got home I was effing pissed off and looking for someone's head on a platter. So, Winning Run kindly gave me the number to the doctor's office and I called for a little chat. First, I spoke with the receptionist.

"Hi. My wife called a little while ago to make an appointment to be see for some minor injuries as a result of an accident last night. You guys told her that you wouldn't see her or that it wasn't covered?"

"I remember, I...," the receptionist began.

"You can tell her it's not covered without ever asking her name or what insurance we have or knowing any other details?," I interrupted.

The poor receptionist tried to fumble through an explanation of their office billing policies. I cut to the chase and got the office manager, Sue, on the phone. In an asinine explanation attempt, Sue said that the office never "declined service" to my wife. They had offered to see her but we'd have to pay for the service ourselves because "insurance" doesn't cover it.

"You're telling me that insurance doesn't cover someone who's been in an auto accident?," I asked incredulously.

"That's right," sayeth the dumb ass.

"What if my wife fell down the steps last night and wanted to come it to see you guys today? Would you see her for that?"

"We'd call 911 and send you to the emergency room."

"For a scrape and a wrist sprain?," I asked.

"Absolutely," she confirmed.

"Ma'am, the paramedics saw her last night and everything was fine. This morning, she's sore and we'd like to get it checked out. You're telling me that insurance doesn't cover it?"

"You'd have to go the ER."

"I'm pretty sure that the insurance company would prefer that we see our PCP instead of going for an expensive ER visit."

"Sir, there is a law that says that insurance doesn't cover auto accidents."

"A law? You're telling me that there is a legislative mandate that prevents coverage? It's not a personal decision by your office but a law?"

"Yes. We share all required information with the insurance companies about visits relating to auto accidents but the visit isn't covered."

This went on for a while and I heard most every explanation under the sun to explain why the "system" prevents insured patients involved in car accidents from being covered for an office visit.

Here's the best/worst part: It's all horseshit. There is no law that prevents anything of the sort. I phoned the insurance company and spoke with them. The guy was pretty surprised that they wouldn't see her***. After confirming with him and his supervisor that there is no law to prevent them from taking insurance for visits relating to auto accident, I ask to formally note a complaint about it. So, he decided to get the office manager on the phone. I wasn't privy to the call but, after being on hold for a while, he returned to share the details of the conversation. Turns out, old dumb-ass Sue was pretty shocked that the insurance company would call and ask her about the issue so quickly. Evidently, she adamantly denied that she'd ever mentioned anything about a law preventing them from billing patients involved in car accidents. It was clear to the guy that she was backpedaling.

Whatever. If you don't want to deal with the hassle of it, don't. Don't feed me a bunch of lines about it being some law's fault. At the very least, buck up and take responsibility. Level with me, don't bullshit me.

*** I know that, by the letter of the law, the doctor didn't refuse to see her. The reality of it, though, seems to be that if you decline to accept insurance coverage for an exam or treatment, you are effectively denying to see someone by forcing patients to opt out of treatment due to the prohibitive cost. (Isn't that why we have insurance?) That, my friends, is infuriating.

Think You Might Have Better Luck?
If anyone out there has been in an auto accident or is purely interested in gathering information, I would not recommend that you call 404.255.5774 and try to book an appointment that is covered by insurance. I would also not recommend that you have a long discussion with Sue regarding the reasons patients must pay out-of-pocket for these visits. Finally, I strongly advise against anyone trying to get their friends to do this at least once or twice a week; I'm pretty sure there are laws against it.