My husband has been taking Lipitor for the last couple of years. This cholesterol lowering medication requires a routine blood test, which he has been doing for 2-3 times a year for the last couple of years.
Our out-of-pocket expense was never more than $3. On his last exam, we were presented with a $53 bill. A call to the BCBS claimed that the test was coded as "non-routine" and therefore went into the deductible. Calls to the doctor's office confirmed that a right code was used and that it was the BCBS who refused to pay.
Back to BCBS where they promised they will "review our claim." Nothing happened. The lab sent us a threatening "pre-collection" notice. We paid the bill. A call to BCBS now said that a "routine" test is considered only ONCE A YEAR.
When I asked when this policy took effect, I was told that it was like this ALL THE TIME! The rep insinuated that our previous lab tests were actually diagnosed INCORRECTLY and that they all should've been coded "non-routine." When I complained that we weren't notified, she threatened with "would you like us to re-process all your other claims as non-routine?" - a subtle threat but I got it. What I resent the most is the fact that the insurance company can (and do) make patients pay based on some arbitrary codes that patients don't know anything about.
Everything should upfront and transparent. This is matter of courtesy and decency – which our current healthcare industries sorely lack.