Tag: Medical Benefits

Caesuras and the blame game

trE

Two poems shared on Substack notes

AI-Generated image: A tangled web of two beautiful African American women; one with a pixie haircut, and the other has a curly afro. They are standing next to a handsome, African American & Native American man in the shadows. In the background, there are skyscrapers around them—the feel of any downtown area of a major city is what the image depicts.

Caesuras

it was in the
caesura, the pause
of his poem when I
knew his pain.

we carried the same
kind—blameless,
deep, unknown to
anyone else.

it felt balanced to
have a partner who
knew what I meant
when I said, “I can’t
talk about this, I
have to write it out,”
and not further
question the
conversation.

losing him, brought
me her a couple
years later, and she
knew what I thought
before I could
express it; a poet, a
performer. I think I
fell for her voice
before falling into
her heart.

but we shouldn’t
have been what we
were, and I never got
over being second
best.

every so often, I
think about him and
her, and the pauses I
have to take when I
see their faces in my
dreams. I am here
because they were
there.

the blame game

the day broke through my armor
and punched a hole in me…
I stumbled and wasted away down
to the ankles… it hurts to walk.
I’ve never suffered a blow this heavy
to the mind during the “BRR” months before.

the beginning of the year isn’t supposed
to feel this way.
tell that to the patients who only want to hear
what they want to hear—in the medical field,
when your insurance cost rises and your
deductible and out-of-pocket maximum do, too…

anyone around gets blamed for their pockets
being just as empty as yours.

Have you gotten your copy of Séduire: Serial Tales & Flash Fiction at Lulu in E-Book & Paperback versions, or Amazon in Paperback (only) yet?

I am on Substack as well. Poking the Bear’s Belly for Fun is a place of healing, as I discuss recent events related to my previous place of employment, including racism and discrimination, the growth I experienced after resigning from that company, and the foibles and overall experiences of life. I welcome your visit.

Please Scrutinize Your Healthcare Bills, People.

trE

I say this as a person who has been in the medical field for 23 years, and who was a medical biller for 10 of them.

AI Generated Image: A Black woman is sitting and reviewing a medical bill. She has a frustrated look as her long curly hair layers lovingly around her face. She is wearing a soft version of a purple top and the background is blurred out.

Earlier today, I had to place a call to my insurance carrier and have them call the billing department for my provider’s office because I have been billed twice for services rendered on the same date.

Disclaimer: I had one appointment on the date mentioned below, and it was for my annual exam only, which is a service covered at 100% by my insurance plan.

I went for my annual exam on 02/18/25 and my provider’s office coded the actual annual exam, it was processed and covered at 100% and paid accordingly, but they also billed me for a 99214 code which is the second to last CPT code for an established patient office visit. One of the highest billed charges for an established patient for in-office services.

Now, I know these people didn’t think they’d get someone who did medical billing for 10 years calling them today with a representative from their insurance carrier, but they got the WRONG one and the RIGHT one today.

My insurance representative informed the billing representative who took the call that they will need to send a corrected claim to reflect the annual exam only (which means, they’re going to end up having to refund the payment for that OV (office visit) code they billed incorrectly, too) and the bill I received from them for $30.00 is currently being held or contested until after the coding review.

I don’t play when it comes to my bills and you DARN sure ain’t gon’ get me because I scrutinize every EOB that is emailed to me. And I do so happily because I have seen way too many people pay bills without actually reviewing them and matching them up with their insurance policy’s coverage and benefits.

People, please review your healthcare bills with a fine-toothed comb. Ensure what you receive is correct and on par with what YOU KNOW is in line with the services rendered.

I was informed I should receive an updated bill and resolution in 7 to 10 business days.

My inner Ghetto Queen is saying, “BAYBAY, I will R O L L up to their corporate office at the hospital and ACT A WHOLE FOOL over $30.00. You not gon’ get me for preventative services that’s covered at 100% with my plan. Nah, nah. You remove that OV code, send a corrected claim, and give my insurance carrier back their refund when it’s all said and done. And don’t do it, and watch me email the CEO of that hospital organization.”

Be on the lookout, beautiful people. Take care of yourself and make sure no one is taking advantage of you and your medical benefits. It’s only going to get worse as time moves forward under this current administration. Mark my words. Stay vigilant, loves.

R A N T  O V E R!