As an office manager (currently unemployed) I am a firm believer in Due Diligence. I believe that in business and in personal things. I try to make sure that all my Ts are crossed and my Is dotted.

I did this a while ago with a cancer screening I had (last one for several years, was clean, yay). I went to my physician who said it was that time of year for me to make my yearly appointment for a Pet/CT scan and that this would be the last for a long time. I went out and found an company locally that would do the test, made the appointment and waited.

Two weeks before my test date their business office called and said my precertification had not been approved yet by my insurance company. I called my insurance company and they said they had no information about the precertification. I called the business office again and we went through my history, every test I had ever had for this, doctors, etc. They said that they would go at it again. I asked at this point (now 1.5 weeks from the test) if I should postpone the test until we were SURE the insurance would cover it. They said don't worry.

5 days before the test I'm worried. I call the business office and asked for them to check on the precert. and they said still no news. I asked if perhaps there was a different test I could do instead that would go through the insurance without a problem, one that would still be as thorough and comprehensive. The lady said no, not to worry, they were sure things would be fine.

Day before the test and I call them again. Sure enough the lady says they got what they needed from the insurance company and I was all set to come in.

Day I arrived I spoke to the lady again, asked again if the insurance portion was fine, if I was covered and was told (in front of my fiance as a witness) that YES, it was!

A week ago I received a nastygram from my insurance company saying they were refusing to pay because they felt it was experimental. I began to write a letter to fight their decision.

Today I got a bill from the business office of the radiology department for the sum total of the test, $4035. I called them and said "but your office told me twice that I was all set and the precert had come through."

THAT was when the truth came out. The truth was that the insurance couldn't precert it as it wasn't an approved test, so the office had requested a predetermination (like a dentist office might) for payment and had never gotten the green light from the insurance company saying they'd pay it. BUT THEY TOLD ME THAT IT WAS ALL SET AND APPROVED. They won't admit to that, they keep spewing that the insurance never precertified it, that the insurance wouldn't cover it, that it was "experimental" and I was now on the hook.

See? See what happens even when you try to do your due diligence you still get screwed???? Had I probed deeper, had I insisting on something in writing it may have slipped at some point that there was no way to guarantee it would be covered. (of course, had it slipped I wouldn't have had the test, would you?)

So now I'm battling with a billing office over whether they should eat the cost of the tests because they misinformed and misled me the entire time and had they ever told me it wouldn't be covered I wouldn't have had the test. If they push it I might have to take it to court, I will NOT pay this because they lied or did not communicate the full extent of the truth.

The Lesson Here? GET IT IN WRITING!!!!