MY Healthcare Problem

AAAARRRGGGGHHHHHHHHHHHH!!!!!!!!!!!!!!!!!

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 getting work done, I schlepped 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 States spends more money on healthcare than other industrialized nations, and yet we receive a lower quantity and quality of care. As Paul Begala noted on Real Time with Bill Maher last week, "what we really spend our money on...in the system is trying to figure out how to not cover people who have paid their premiums. " 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?

References:

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:
http://www.miller-mccune.com/health/racisms-hidden-toll-1268

Comments

[RachelIowa]

Amen! Thanks for sharing your frustrations--glad I'm not alone.
A few years ago I was bitten by a dog. I went to an Urgent Care clinic for treatment. Despite my excruiating pain, I called my insurance company to make sure that the place I was headed was an in-network clinic. Because the clinic was in a hospital, I ended up being charged the ER co-pay ($500) instead of the Urgent Care co-pay ($100). After about 10 phone calls, disconnects, insurance jargon about forms #'s, and severely rude treatment the whole thing was taken care of but only after a customer service SUPERVISOR had the nerve to tell me that I would have to "request that the hospital change its federal tax ID number" so that the billing could be processed as a clinic, not a hospital. Seriously?!
I am a person with insurance and at-least average intelligence. If I struggle to navigate this system, what must it be like for the uninsured? Those with cognitive impairments? The current insurance industry works for people who can pay their premiums and who never get sick. Period.

[HeatherColorado]

I absolutely agree with Ferber and have similarly wasted countless hours in just this kind of frustrating endeavor. My other pet peeve with the medical billing process is that every provider seems to send out at least 5 bills for every visit/procedure. When I have questioned staff about this process, I have been told, “The computer does that automatically, we have no control over it, just ignore them.” As if this is some innocent (and not-costly) computer error. Personally I believe this is a very intentional technique to try to trick people into paying medical bills their insurance company should be paying. Watching the confusion and anxiety my 92-year-old grandparents face as they try to make sense of the already crazy number of medical bills, compounded by getting multiple ones of each, makes me want to scream.
I think one of the most important points Ferber makes concerns the anxiety produced by our current system. I lived in the UK for a year and LOVED that my medical care was not something I had to worry about (or pay for!).

[calexis66]

Actually that happened to me when i needed a medical procedure. The doctor's fee was separate from the hospital fee and I owed about $500. I pay $492.00 for supposedly the best insurance available in my small business association, and I'm still not covered the way I should be. My high insurance premiums coupled with the fact that we are now a one income family has made it very difficult to pay our bills. I don't even want to think what would happen if my husband or I came down with a serious illness. That is why I do what I can to take responsibility for my own health, to keep my immune system strong, eat a healthy alkaline diet and educate myself and other's on maintaining optimal health and wellness. The doctor's and the insurance companies are part of a corrupt system that benefits from keeping people sick. With a single payer option and a large cut in the waste, (unncessary tests, better records, no more expensive emergency room visits for those without insurance, coding problems) combined with a serious focus on prevention, maybe we can create a better system where doctor's do what they intended to do when they made the Hippocratic oath, to be HEALERS. Meanwhile, I'm happy going to my chiropractor, naturopath and educated my self on wellness...

Carol Perkoski, Cleveland OH

[droftim]

"Our healthcare crisis is not only a crisis for the uninsured."

This is a key point that every Democrat in Congress needs to repeat at every opportunity. Instead of talking about the "46 million uninsured" and painting healtchare reform as a poverty program, our legislators should point out that very few people are able to escape the consequences.

Ferber is tells us she's lucky to have a generous plan but the details are quite telling. Her choice of doctors is limited by the insurer and the treatment that will be covered depends on the "coding" analysis of the insurance "representative".

When opponents of single-payer start ranting about loosing our choices and rationing care, ask them about the limits on their current plans. Ask them too how much more their company covers than it did 5 years ago. Most are cutting back and have instituted higher copays. If we don't REFORM our payment model, we'll soon find that government workers will have fully covered, employer-paid coverage ... for which less and less adequately covered taxpapers are paying.

[masscitizen]

This article is DEAD ON! This is what your private pay, for-profit insurance system gets you - hours and hours of stressful arguments with faceless claim reps who appear to all be reading from the same insurance claim manual featured in that Grisham novel and movie - someone please tell me the name - it essentially sent your claim in a never ending circle, never to be paid. They take your premiums, stuff them in their pockets and spend all their time figuring out ways not to pay your claims. It's outrageous. I've had similar experiences. A family member had this experience when she had an aggressive, life-threatening cancer and needed a treatment urgently. If she had played along, appealing and re-appealing her denial, she would have died in the meantime, an outcome they were surely hoping for as it would have been cheaper for them. Lucky for her, she was able to get a legislator and I think a reporter involved and poof, the treatment was approved. How many others died?

[LeftRight]

This makes about as much sense as the whole issue of electricity in Illinois! In 1997, the state did two things. It created a private organization to run the system, and it locked rates in for a decade. By 2007, that one private organization had turned into TWO private organizations, Commonwealth Edison to DELIVER the electricity to your home, and Exelon to generate the electricity. ComEd is WHOLLY OWNED by Exelon!

So 2007 comes around, and they hold an "auction" to determine the new electric rates being delivered by ComEd. Surprise, surprise, Excelon gets the bid (being the ONLY organization in the state that generates electricity) at around 200% of the previous rates. ComEd then has to "pass the increases on" to consumers, since they are broke.

The reason that they are broke? Because every dollar of profit that they make is being sent to Exelon. And so they are buying a product from themselves, shipping it themselves, and selling it to their customers, all the while claiming to be broke, even though their parent company has BILLIONS sitting in the bank!!!!

[MBAA]

I agree with this article. I am the CEO of a company called Medical Billing Advocates of America. We have 67 advocates across the US that help consumers fight for a true & accurate bill and for full benefit coverage from their insurance. Most working families do not have the time to fight their insurance and provider for a job they are suppose to be qualified to do in the first place. We as consumers, do not get paid to do their job or fix their mistakes, DO WE????? Thank GOD we have billing advocates that have the time and expertise to do just that. One case I have worked some time ago. This lady had insurance and always paid her very high premiums on time. She started receiving medical bills requesting large balances. Having insurance she did not understand why she was still asked to pay so much. She contacted our office for help. After investigating her medical bills & insurance; it was plain that her insurance was denying claims as met yearly max. Her insurance had a yearly cap on certain services, ex: labs, x-rays, once the cap was met all claims for in-network providers were denied for that reason and she was left to pay the FULL billed amount. After arguing with insurance to send all in-network claims back thro to process with in-net provider discount, she received a check for $147,000.00.