Didn’t work. I got frustrated.

If you’ll remember, back in December I lamented that it appeared I was going to have to pay for my annual mammogram because it was coded as “diagnostic” rather than “routine.”  As I said at the time, I balk(ed) at having to pay for the same smash-your-boob-in-the-machine mammogram every other woman in my plan gets covered for free. (As do a lot of women without any insurance at all.)

So I went through the appeals process and guess what I got in the mail today? Yes, you are correct, a letter that was clear in nothing except one line:

Thank you for choosing the UPMC for your medical care. Our primary mission at UPMC is patient care and customer satisfaction that is based in a strong commitment to excellence. [I’m an editor, so why “the UPMC” in the first sentence and just “UPMC” in the second? And shouldn’t it be based “on”?]

After careful review of your medical records [need a comma here] it has been determined we are unable to honor your request for an ICD-9 diagnosis code change on this account. ICD-9 diagnosis codes are used to identify diseases and conditions, and provide justification for any procedures performed on the patient. The ICD-9 code chosen for this procedure was found to be appropriate according to the highest level of specificity. [What?]

[Here comes the clearest part of the letter] Payment is expected immediately….

I wasn’t even going to bother to call for clarification, but I did. I was told that UPMC did contact my physician, as they said they would, and she wouldn’t change the code. So, I’m stuck this year. Next year I will be vigilant in requesting (or obtaining) only a ROUTINE mammogram (and I’m sure I won’t be able to tell the difference).

What this letter SHOULD have said was something like:

We understand you are questioning the diagnosis code on your mammogram. We contacted your physician (insert name) and learned that the coding of “Diagnostic” rather than “Routine” was correct and cannot be changed.

Instead, I got a generic letter with a Senior Account Representative’s name on it, but no signature. And I had to follow up by phone for clarification.

How hard is it to write a letter that clearly explains a situation? Even though it was delivering bad news, a more personal, factual letter would have gone a long way toward making me feel like my concern had been heard and addressed.

Now I’m not sure what I’m more frustrated about: having to pay for a mammogram that should have been covered or feeling like I got the runaround, even though I actually didn’t. Or maybe it’s being reminded, once again, that the written word is so powerful and yet so often underused.

Be obscure clearly.
~ E. B. White

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3 Comments

  1. Monday, January 25, 2010 at 10:01 pm

    Wow, you couldn’t write a better (or do I mean worse?) parody of a letter if you tried! I gotta go with more frustrated over the lack of appreciation for good writing. But, I’m biased (am my mammograms are covered.)

  2. Facie said,

    Tuesday, January 26, 2010 at 9:11 am

    I am mad for you. Of course, I am still mad about Jordan’s staple fun, about one year later. I would almost be tempted to send them the rewrite, which, of course, no one would read and no good would come of it.

    More and more I see how people just don’t want to see a better way, from restaurants, to schools, to medical care. Status quo bites.

  3. WritingbyEar said,

    Wednesday, January 27, 2010 at 11:59 am

    Well said, Facie — Status quo bites! And right you are BoatDrinkBaby — I ended up deleting a paragraph lamenting how people balk at paying a writer to help them communicate more clearly (too self-serving).


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