Arguing claims already

ETA: This letter was in response to my consult with the perinatologist claim being paid at the deductible/coinsurance level, rather than at the specialist copay level. The hopspital billed it as outpatient services, rather than as a doctor's visit. That's supposedly how they bill all their doctor visits.

Hi Claims Representative,

Thank you for looking into this for me. Excuse my tainted outlook on this, but it seems to me that the hospital has found a way to bilk not only Insurance Company, but me as well, for all they can get, and then some.

I went to see the perinatologist for an initial consult, to make sure that she or someone in their practice would care for me if I get pregnant. If I do get pregnant, I will be considered high risk and will need to be under their care, as well as my OB/GYN. The closest perinatologist to me, as there are none here in Pueblo where I live, is located at Unnamed Hospital in Colorado Sprigs.

If I see them at least four times, Insurance Company, and I, will be paying for a higher level of service than actually provided. My benefits through my employer state that if I see a specialist, my copay is $30. It is not subject to my deductible or coinsurance.

I understand that Insurance Company is somewhat limited as to what it can do, but I think that it is unethical to charge me a higher amount because of their inability (or their refusal to bill otherwise) to file the claim differently.

Please let me know if this can't be argued further with Unnamed Hospital. If not, then I'd highly recommend that your provider relations people work with Unnamed Hospital so that members like me, who have to use their providers, don't get bilked for more than they are legally responsible for.

Thank you for your time.