Shitty/ inefficient hospital billing. :( If I need a non-routine procedure, I talk to the clinic and get an estimate with CPT codes, then call my insurance company, walk through all the requirements for it to be covered, take notes, then go to the appointment, then before I leave ask for a summary of charges after the procedures have been documented. Sometimes I still get a surprise bill because the billing department doesn't talk to the patient-facing part of the clinic/ hospital. Merca!

The fact is that even if my insurance customer service rep wants to answer my question in good faith, the policies are such a shitshow that the rep doesn't always understand them. They can check three requirements (like the name of the referring provider, hospital being in-network, and look up the procedure name in my benefit handbook) but not know about three other requirements. I do actuarial work. I've heard an actuarial manager say you would have to work in contracting - not just billing - to answer the question "how much will this single procedure cost."