Tweezer “surgery”

I am not making this up. A twenty-something young man went for his regular eye checkup. The ophthalmologist casually mentioned that a stray lash was grazing the man’s eye and suggested that he, the doctor, remove it. The man gave the go-ahead. Using a pair of drugstore tweezers, the doctor plucked the lash.

A few days later, the bill arrived. It said “Revise eyelashes, forceps. Surgical $335.” The young man was responsible for $198.97 of that.

The doctor’s office was in network. The ophthalmologist had billed the man’s insurance for $1,085 for the office visit, and the insurer paid $545.20. But the eyelash pluck was extra. It never occurred to the man that he’d be charged for it. He filed grievances, both with the physician’s billing office and his insurer. Both were denied.

Insurers negotiate rates with their in-network providers. Patients are usually not responsible for the difference between the provider’s full charge and the amount the insurer pays, something called “balance billing.” The insurer had agreed to pay $198 for the eyelash pluck, but since the man’s deductible hadn’t been met, he owed that amount out of pocket.

Taking pity on her son, the man’s mother took on the case. She called the physician’s billing department and was told that the patient should know what’s covered. Nevertheless, the mother dug in and finally prevailed. The doctor’s office rescinded the charge.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.