Pierce and Pierce Insurance Woes

A while back I wrote about the procedure done to determine whether I had skin cancer.  I had 16 moles biopsied and/or removed on my body.  Needless to say, waiting to know if you have cancer is extremely unpleasant, especially considering that it was a painful procedure that took me weeks to recover from.  I didn’t end up having cancer, but 11 of the moles were abnormal and the doctors had to remove even more flesh around them.

Right before the first procedure happened, I was advised by the dermatologist’s office that I needed to find out what labs were covered by my insurance so I wouldn’t end up having an extremely expensive lab bill.  I called the insurance company I had at the time and they gave me a list of covered labs, and picked one from the list.

A month ago, I received a lab bill from them anyway, for $2100.

Obviously, this was a shock to me.  $2100 is a lot of money for a guy like me, who is currently living off government assistance to help me get a degree.  My wife works two jobs and we have two children.  I can’t just wave my hand and conjure up that kind of money.  The last time my car broke down I had to release an album to get the funds to pay for it.  Furthermore, my consternation was amplified by the fact that it was a lab that supposedly was covered by my insurance.

So I called my insurance (Pierce and Pierce insurance, which was the mandatory insurance for graduate students at Georgia Southern University at the time) and asked them what gives.  What the lady on the phone told me shocked me even more.  Apparently they only cover skin biopsies if the results come back malignant.  That’s right, there’s no way of knowing whether the test is paid for until the results come back, meaning that the choice was between paying for 16 biopsies, or having cancer (and having the tests paid for).  With my financial situation, I’m not sure which I would have chosen.

I guess I should have been aware of what my insurance would cover, which means reading through the 30 pages of fine print I had to sign just to get it.  But it was the mandatory insurance for Georgia Southern students, and opting out of it would also have been a painful and involved process.  Plus I’m not sure whether this is standard practice among insurance companies, and never could have predicted that I would have so many abnormal moles that would one day need to be biopsied, when I signed up.  Maybe all insurances at this price level wouldn’t cover biopsied moles that only come back abnormal and not malignant.

However, the lady at Pierce and Pierce told me that I could appeal the decision if I could get my doctors to write a letter stating that the procedure was “medically necessary.”  The irony should be obvious that the point of a biopsy is to determine whether I have a serious condition – we didn’t know if the biopsy was necessary until the results come back.  If I can get my doctor to write that letter, then it’s up to Pierce and Pierce’s appeals board (or whatever) to determine whether my procedure really was “medically necessary” and therefore covered.

Obviously, I don’t know what incentive their appeals board has to pay for my procedure.  They make money by denying claims.  They hold all the cards.  I’m not even a paying customer anymore – Georgia Southern has switched their mandatory insurance to a different company (perhaps due to people complaining about crappy service at Pierce and Pierce).

But why wouldn’t an insurance company have incentives for preventative or exploratory procedures?  They would obviously be paying much, much more if I neglected to go to the clinic until I did develop cancer.  Abnormal moles very often turn into cancerous moles, so wouldn’t they rather pay a little bit now than a lot later?

This is just one of the many problems I had with Pierce and Pierce.  For instance, I once had an asthma attack on a holiday, and the clinic I went to couldn’t call them to verify my insurance, so I wound up in the ER.  I don’t like going to (and paying for) the ER if I can help it, but I couldn’t help it thanks to Pierce and Pierce’s horrible verification process.

I’m not writing this to complain about the health care situation in the United States (though if you want to do that, by all means, feel free), nor is it a plea for money (we can get on a payment plan if we have to and just work it out), nor am I trying to be political or a whiner.

I do hope, however, that anyone who is considering Pierce and Pierce Insurance (it is now called Chartis Educational Markets), perhaps due to it being mandated by their school or company, who has a history of cancer should be aware that they may not cover biopsies unless they come back malignant.  You should consider opting out of the insurance and finding something better.  They’ll probably make the process difficult, but it would be worth it to save you some money.

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