Okay, now that I got that out, let me tell you about how I spent my day today. Today, the day marked in bold red letters on my calendar: Work on Research. Today, a day my daughter is at camp, and I had planned on getting lots of work done. This is how I spent my day....
I called my daughter's doctor's billing office to find out why I was billed for her recent office visit to see an orthopedic specialist for knee problems. (This, of course, was how I spent another day recently, when, instead of working, I shlepped her to doctors and radiologists to diagnose her sudden knee pain). I am one of the fortunate Americans with very good health insurance. We pay a small co-pay for office visits, and insurance pays the remainder if we visit in-network doctors. I learned from the office that the insurance company had not paid for the clinic visit. Because the doctor is associated with the Children's Hospital here in Denver, the Hospital submits the clinic facility charge separately from the doctor's fee. I was also informed that I owed over $500 from previous office visits she had with various doctors dating back well over a year, that had also never been paid by United Healthcare. It was déjà vu. The horrible memories started pouring back. I had been through this all about six months ago, and had thought the issue was resolved, and the bills paid by the insurance company.
Next call was to United Healthcare. After working my way through their voice mail system, sitting on hold, then explaining the problem to an agent, she decided to connect me to a specialist on their "rapid response" team. Things were looking up. Finally someone will help get this resolved, I thought. Once connected, I heard a recording telling me "One moment please," every 30 seconds. I am positive it was every 30 seconds because I had the opportunity to count the seconds dozens of times. And this was the "rapid response" line...I should have known then I was in trouble.
It turns out that this new bill which they denied was denied for the same reason all of the past bills were denied, because the clinic fee was associated with a hospital, they applied the fees to our hospitalization deductible. It did not matter that these bills were for routine office visits. Because the doctors are affiliated with a hospital, they were denied. This was all starting to sound familiar. I started to plow through my file of paperwork tracing call after call I had made between the insurance company and the Children's Hospital over the past year, trying to get this resolved. After days of calls back and forth between the two offices, the insurance company agent resubmitted the claims, explaining to me that she thought they should be covered and did not understand why they were being rejected. The agent told me I would hear back in ten days. I never heard back and assumed the bills were paid, case closed. That was my mistake.
Today another party entered the picture. It occurred to me that I also see physicians associated with the University Hospital system. After all, we are quite lucky to have this world-class facility here in my home town. So I wondered why I have never had these problems with my own visits. I called the University Hospital billing office, which is separate from the Children's Hospital billing office, even though they are both part of the same system. I learned that I had no outstanding balance for any of my visits to those physicians, even though they used the same system of billing for both a physician's fee and a separate clinic hospital fee. I asked for examples of dates of service when the insurance company had paid this fee, and was told it would take a week to get that information, because I did not have the account numbers for each of my visits, so the agent would have to go research my files. So now I am waiting again. Even once I get that information I am not sure if it will help my case with the insurance company, where a very nice customer service agent insists the problem is with how the clinic fee is coded and billed. A friendly representative at the clinic, on the other hand, says it is the insurance company that is making the decision to apply the charge to my deductible ,and that they are using standard coding and billing procedures, thus there is nothing they can do about it. The representative insists that it is the insurance company that is at fault and should be paying these bills. What is basically a coding problem is now my problem; I am still stuck in the middle. I can't get all of the parties involved talking together to figure this out, so I am playing phone tag for hours, days, now months, moving between each office and various agents, increasingly frustrated and no closer to resolution.
This is one of many reasons why private healthcare does not work. We have one of the best plans and most coverage available. We are lucky. And still, I spend literally hours and hours and hours just trying to get our doctors' bills paid. Not only are we lucky to have this coverage, I am highly educated, and not easily intimidated. I know my rights. I am also fortunate to have a job with flexible hours. I can work at home many days, and thus spend time during normal business hours calling one office after another to get this resolved. And with all of this education, time, and resources, I still can't figure this all out and get these bills paid.
Health insurance companies are not in the business of making healthcare easier for us; they are in business. As a business, their goal is to make money. The United Status spends more money on healthcare than other industrialized nations, and yet we receive a lower quantity and quality of care. A single payer system would eliminate all of these problems, and the money spent reprocessing these claims over and over could instead be spent on improving care. Our healthcare crisis is not only a crisis for the uninsured. There are thousands upon thousands of insured families, who spend countless hours dealing with insurance companies and doctors' offices struggling with these kinds of issues. There are mothers of terminally ill children spending precious hours fighting with their health insurance companies. And it is usually women who perform this unpaid, stressful, emotional, labor. Research has documented "women's greater responsibility for organizing the medical care of other family members" (Bird and Rieker p. 150). So there is also a gender dimension here. The current organization of our healthcare adds to the burden of women's unpaid labor. Between the "double shift" of work and family responsibilities, none of the women I know have time for this.
There is also "substantial evidence that stress affects health" (Bird and Rieker p. 123; see also Blitstein). So ironically, the added incalculable stress of fighting with insurance companies is potentially making us sicker and increasing our need for care. And it is stressful, let me tell you. I have the urge to run to my doctor for some anti-anxiety drugs right now, if I wasn't so worried it would lead to another unpaid doctor's bill...
That's MY healthcare problem. What's yours?
Gender and Health: The Effects of Constrained Choices and Social Policies by Chloe E. Bird and Patricia P. Rieker, Cambridge University Press, 2008.
"Weathering the Storm," by Ryan Blitzstein, Miller-McCune July/August 2009; pp. 48-57. (see article at: Miller-McCune.com)