First of all, I have to meet my deductible. After my deductible, I have to meet my co-insurance target of 10% of allowed billing per procedure. That runs up to my out-of-pocket expense limit, except, of course, for those things which do not count toward my out-of-pocket expense limit.
Clear so far?
Then there was the problem of two of Mother of the Child's bills. For preventative care. Which is supposed to be covered for the full amount, not applying to the deductible, co-insurance, or out-of-pocket expense limit. Except when it's not covered. Because, say, MotC saw a resident instead of a staff physician. (We get our healthcare from a major teaching hospital with associated clinics.)
It turns out that when you see a staff physician, the billing code the insurance company receives is associated with that doctor's Tax ID number, and is processed as a consultation with a physician. When you see a resident, the billing code the insurance company sees is a clinic services code, because residents don't yet have Tax ID numbers, and so it is processed as a clinic service.
Physician consultations for preventative care are covered in full. Clinic services are subject to deductible, co-insurance, and out-of-pocket expense requirements. The net result is that I or MotC or the_child can see a fully accredited staff physician for no cost to us whatsoever, or we can see a resident — ie, a brand new doctor still in training — and pay about $115 for the privilege of being seen by a far less experienced doctor.
All because of billing codes.
What? The? Fuck?
The response of the hospital billing department? "Well, yes, that's how it works. In the future you'll need to be prepared to pay the deductible amount for seeing a resident."
Me: "So what you're saying is if I don't want to spend $115, I need to insist on a staff physician appointment."
Hospital billing department: "Well, yes."
Me: "That is some really screwed up customer service." (Not to mention some screwed up physician training priorities.)
Hospital billing department: "That's how it works, sir."
Nope, the healthcare financing system in this country doesn't need any fixing whatsoever. Nosirreebob. Only a Socialist could think there was anything wrong with this.