Reasonable/customary is unreasonable

Out of 10

I had to have an infiltrative lipoma removed from my pup's hind leg 10/08. The surgery was over $900 (and this was less expensive than most surgeons would charge--I got quoted $2000 at one hospital), but I felt that a reason like this was why I pay for insurance. After confirming that the surgery would be covered, I submitted the claim. Approximately $400 was reimbersed. When I called to inquire why, I was told that there was only one classification of lipoma that was used to determine reimbursement. When I explained that a surface lipoma was less risky and less intricate to remove and therefore less costly, I was told to submit all medical records, labs and surgical notes so the amount could be adjusted. After doing so, I waited 3 months only to be told that my appeal was denied because their reasonable and customary charges only allowed for what I got back. I am now planning on changing insurance carriers. For the premium I pay per month, I expect more--especially when I got the insurance to help us in the worst-case scenarios like this one. The only good thing about my experience was the customer service rep I initially spoke to when I called to inquire about the reimbursement amount--she was patient, understanding, and very considerate.

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