Thought I booked a well woman but charged as a diagnostic with a big bill
So I went to a new gyno since moving to a new place (NYS resident). I scheduled a well woman/ annual appointment on the phone. I told them I also had some questions about my birth control too. I have been on said birth control for 7 years. I got to the appointment and everyone was so nice! The doctor went over my risk factors and said I didn’t need a Pap smear at all! He didn’t even want to do a breast exam. I briefly mentioned the birth control (I had had spotting but nothing too unusual). He said I should stay on it if I wasn’t having other issues and gave me a prescription refill. I thought it was odd he didn’t want to do a pap (it has been over a year for me).
Today I get a bill in the mail for $115. An annual gyno appointment is supposed to be fully covered by my insurance. I call the insurance and they said because I discussed birth control it’s a diagnostic appointment and that is how the office coded it. They tell me to call the office and have the code changed and resubmitted.
I call the office and they say they can’t do that because it wasn’t an annual since I didn’t get an annual or a breast exam. They said they didn’t know I wanted an annual(even though that is what I requested on the phone). I ask to have the billing person call me later to make sure.
I call the insurance again, they say there is noting to do other than file a grievance so I do.
Billing person at the office calls and tells me that there is nothing they can do and I should file an appeal. They tell me next time I would need to insist on a pap smear. They say if i even mention birth control though and get a refill it is a diagnostic appointment.
So I checked the website for my health insurance tonight. 1) An appointment with a specialist should be a $40 copay. 2) Nowhere does it say I need to pay $115 for a diagnostic appointment. 3) In our contract it states, “We cover… patient education and counseling on use of contraceptives and related topics; follow up services related to contraceptive methods, including management of side effects, counseling for continued adherence, and device insertion and removal;…”
So this seems wrong. I’m really frustrated since I thought I had made sure it was a well woman appointment before and was happily surprised I didn’t need a pap. I just wish someone had said that would cost me $115 if I declined.
What can I do here? Has anyone had a situation like this before? I would appreciate any advice.
I am thinking of calling NYS department of health complaint hotline, or the community health advocates the state consumer assistance program.
submitted by /u/cbs2022
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