A deductible and coverage nightmare

Sue was told by her insurance that she doesn’t have a deductible for an office visit and that SPARCC is in-network and has been authorized to see her son, Max, for his concussion. To any non-expert of insurance, that means the visit will be covered and paid for minus maybe a co-pay, so Max comes in for some Concussion Management appointments.

Our docs are on the leading edge of concussion management research and care; they follow the active rehab protocol, perform cognitive testing, and test for markers such as balance, dysautonomia, and vertigo.

Two months down the road, Sue is shocked when she receives a large bill. While she did not have a deductible for “office visit”, insurance companies categorize tests as diagnostic, and for those services, she has a $5000 deductible. This means cognitive testing and active rehab are applied to her deductible and since she hadn’t met her deductible at the time of the visit, she is responsible for those costs.

Unfortunate scenarios like these put strain on Sue and on SPARCC, and full understanding of how insurance really works is the only antidote. That’s why, at SPARCC, we’re trying to clear up the insurance picture for you as much as possible.

 

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