I twisted my knee. Before long it is too sore to ignore, so I
check with a physical therapist at the gym. He says he can fix it and that he
is a preferred provider on my insurance; his services will be fully covered. So
I visit him nine times over two months. My knee is better.
But my mind is boggled. A week after the final scheduled PT session, I get a nine page so-called “Explanation of Benefits” from my health plan. For each visit, there is a not-a-bill
on which I’m not-billed separately for Exercise Therapy, Body Movement Therapy,
and Muscle or Nerve Trai. I’m not sure what that third item is, or if I had it, or why the provider billed $50, the plan
allows $33.46, so I owe $33.46.
The Note says “3024”. So I
hunt through the pages and find a
section labeled NOTES. Here is Note 3024 (their caps): SEE THE “REHABILITATION
SERVICES” SECTION IN THE ALLOWANCE SCHEDULE OF YOUR CERTIFICATE OF
COVERAGE.” What? Looking further, I see on the back of each page that if I
disagree with the payment decision, I can “submit a request for appeal within
180 days of this notice”. It
should be in writing and include copies of my medical records. Who has their medical records? I can’t object to the decision since I can’t determine what the procedure is. I don’t have a clue what the price should be. I give up and take the stack of papers to my husband; he’s a
lawyer. After a 15 minutes pouring
over the pile, we conclude that
this not-a-bill says the services, including the mystery procedure “Nerve
Trai”, are covered, at least
partly, but the insurer is not
going to pay; perhaps because while the individual deductible has been
satisfied, the family deductible
has not. But the the employer says
there is no deductible on our plan... It seems the take home message is, “You
might get a bill.” Hardly and EOB.
More like a “Not-an- Explanation of No-Benefits. This story would suggest that, despite the PhD and 30 years in
health services, I have low health
literacy. That is, I do not have the capacity to process and understand
information necessary to make appropriate health decisions. Likewise for my
husband the trial lawyer. I’ve been impatient with the Plain Language crowd, thinking that
surely we all know about readability and jargon and all that by now. I am wrong. Really wrong. Keep at it Plain
Language advocates! |