I'm Sorry, Mr. Obama, We Don't Accept the Senate Health Care Plan Here.

National health is the bogeyman of insurance companies, who have in turn fanned the flames with physicians and the general public to keep their fat businesses open and churning out the same inconsistent, poorly run mess that we've had since guys with big white smiles started knocking on doors and selling "health insurance" in the last century. Each company, even ones with the same name, do business differently in different states. For Obama, the challenge will not only be bringing people into the healthcare system, but ending dozens of fiefdoms and bringing more uniform quality care to Americans along with simple access.

If you want the point driven home to you, travel with your healthcare.

I am a citizen of the Sunshine State of Florida, and a holder of a private Paid Provider Option (PPO) health care plan administered by Blue Cross & Blue Shield of Florida. I recently took a trip with my family that landed me in the Realm of Blue Shield of California.

In Florida, our company of the same name has high deductibles for personal insurance, pays out very poorly on pharmacy benefits, and is very big for its PPO customers on the use of Urgent Care rather than the old Emergency Room when you have a problem that is short of immediate death.

In California, their personal plans, which, after years of consumer advocates fighting Big Blue, are part of a very big pool of insured that even dwarfs the pools of many private employers. They have exceptionally good pharmacy benefits, much less draconian deductibles, and generally better benefits for its subscribers at a lower cost than we do in Florida.

My wife had a bad head cold. She was worried that she might be getting an infection. When you're going to fly across country in a couple of days, that is not something that you want to leave until you get home, as the airplane and the pressure alone can make you a whole lot sicker. She wanted to get checked out before she flew, and our physician was, of course, several thousand miles away.

We learned, from our one experience last year with an "out of network" outpatient center that you can pay thousands of dollars that would have been covered on the in-network plan, and, in spite of those clever charts that Blue Cross showed us, out of their network you are pretty much at the mercy of the providers in a very costly system. Thus burned, we wanted to find an in-network Urgent Care that was under our health care plan.

I went to the Blue Cross of Florida website. They only list companies inside the state. They do not have a suggestion as to what to do when you are on the road. So I called.

While I was not shipped off to some call center in India, after spending about four minutes navigating through all of the questions about my call that had nothing to do with seeking health coverage in faraway California, I waited about four more minutes and was connected to a woman we'll call "Tonya."

I'm not sure if Blue Cross gives their customer service employees special training to achieve that put-out monotone, or if they put them in a dungeon, or a dank basement to get them to sound like they hate their jobs that much, but Tonya was about typical of my phone calls to the insurance company.

She ran down the checklist of things that she is supposed to ask at the entry of the call. When I told her that I was needing to know what to do about finding an urgent care facility out of state that was covered under my plan, she put me on hold, then she came back and told me to contact the local Blue Cross and Blue Shield provider in California to get their list.

I went to their website, figuring that I could get a list of providers. No such luck, unless you were a subscriber. It required a password and account.

So I called their 800 customer service number. All of the options were for California subscribers with an account as well. Nothing for out of state Blue Shield members.

I hung up, thought for a moment, then called back, and tried pressing "O" to see if I could get someone. Even though it wasn't a choice, it worked.

Speaking to another "Tonya" I was put through my paces of my member number, which I didn't have, and all of the potential issues that weren't mine until I politely told her that I was from another Blue Cross/Blue Shield and needed a list of Urgent Care centers that were approved.

"I don't see why our list would matter to your Blue Cross. They're not their centers," she said.

I had to explain to her that this was the instruction of my insurance provider. She put me on hold for three minutes, then came back.

"They're on line," she shot back rather curtly. When I explained that it had a security account/password feature, she told me that there was a link at the bottom. I went back to the page. Sure enough, in the tiny print there was a note that you could click there if you didn't want to sign in to get this list. I asked her why bother, then, having someone sign in if you can bypass this screen in the first place.

"I don't make the website," she said. "They want you to log in if you have a subscriber number."

Never ask a common sense question to a bureaucrat. It isn't their system. They just work there.

I downloaded the list, after nearly 35 minutes of trying to get the information. There were three urgent care facilities listed in the area. The ones closest to me had both closed. There was one in downtown San Diego, 15 miles from my hotel. Just then, my sister-in-law, who lives in the area, called. I asked her about the place in downtown San Diego.

She told me to call Scripps, one of the finest medical facilities in the world, which was two blocks down the street. She said that they take my plan.

I called. They did.

Yet they were not on the "official" list. My wife would have had to travel miles to a facility when one that was able to help me was literally less than a quarter-mile from my hotel because the bureaucracy at Blue Cross doesn't keep information up-to-date.

I tell this tale of daily life that most, if not all, of you experience because this health care hassle is emblematic of how broken our medical system has become.

Dozens of sloppy bureaucracies make it difficult enough to get what you pay for in your home state. Traveling out of state with your health plan can be like going to a foreign country, even when you are with one of the biggest insurance networks in the country.

This was an easy and non-life threatening situation. Imagine you or your loved ones having to wade through this mess if you get hit by a car out of state, or someone mugs you in a shopping mall.

I can only imagine what happens when you have a regional provider who covers the East or West, or a handful of states, and you travel out of their coverage zone. How many doctors in California will even know what to do with the Iowa Mutual Health card, or the Lovelace of New Mexico card that you carry?

When physician acquaintances of mine give me their sermon on the Mount about the evils of National Health and its bureaucratic nature, I have to laugh. Their offices struggle with five, ten or twenty of these fiefdoms and their myriad rules and payment regulations daily. Many caregivers in our state won't even deal with Blue Cross/Blue Shield of Florida because of the immense hassle.

When Mr. Obama gets to the subject of national healthcare, getting the same insurance as the congressmen and senators in Washington D.C. is not going to be enough. His health insurance team is going to have to tackle the mess that this quagmire of insurance companies has made of the healthcare system, and streamline it.

The 50 year old man in San Diego should be getting his medications for the same price as the 50 year old man in Vero Beach, Florida. If the guy from Vero travels to see his friend in San Diego, he should have the same rules, and same access, and same benefits wherever he goes from East to West, whether he is with Blue Cross, Blue Shield, or Spanky's Super Duper Health.

In the current system, it is possible, even likely, that our President-Elect, even with his spiffy senate plan, might find himself faced with:

"I'm sorry, Mr. Obama but we don't take your insurance. You might wait until the 19th when you become President. Then we cover you."

Comments

[oafishcad]

Of course single payer is the answer, but it would never get past the GOP or the Democrats who've bought the Conservative think tank propaganda and the election money they've taken from those making trillions keeping the system the way it is.

[Spoons]

Way to give up before the battle is even fought. People said the same thing about ending slavery, giving women the right to vote, Civil Rights, etc. The battle for health care justice and the end of discrimination against sick people in America is not much different than those. I for one will not give up until I am unable to fight. If you are able, you must stand up for what is right and refuse to support what is just plain immoral, overly expensive and wrong.

[Brian Ross - Huffpost Blogger]

Right on, Spoons!

[wolfgangmo]

Part 2

The US spends over twice what any other industrialized nation does and we don't offer universal health care. And according to a recent study published in the New England Journal of Medicine, wait times for ER's and specialists in the US are longer than most other industrialized nations UNLESS you can pay cash up front [i.e. unless you are a member of the uber rich]. For everyone else who either don't have insurance or have bad insurance, then you can just wait and you can just die.

US big companies are being destroyed by health insurance costs. In order to preserve our industries we need to get this monkey off their back. US small and mid sized companies can't compete with the big boys for the best quality employees due to being priced out of health insurance. Given the small and mid sized companies employ more people and drive the economy, we need to get that barrier removed for them too. Then they will be able to attract and retain the high quality employees that will allow some of the these companies become global competitors.

Employees are often "stuck" in dead end, soul numbing, bad jobs simply because of the health insurance. Let's give our citizens the ability to pick jobs that are better for them, their families, and their communities.

That's my rant. Private insurance is the disease. Single payer is the cure.

[wolfgangmo]

Part 1

Disclaimer; I own a primary care clinic that does not bill ANY insurance, I used to work for BCBS 17 years ago, I was raised in Canada.

A few facts;

The private insurance in the US is pathetic. Canadians traveling to the US routinely pick up travel medical insurance at about $10/day that covers them pretty close to 100% here in the US. Unless you are rich already then it is likely that the insurance that you have is completely inadequate.

Our clinic does not bill insurance because the insurance companies were driving us out of business. We spent 50% of our time fighting to get paid and our patients covered. We now spend more time [up to 10 times] with patients at a lower cost overall to the patients. No more calling and waiting on the phone for hours to get procedures pre-approved. No more writing letters of medical necessity and not more writing letters of appeal. No more waiting months or years to get paid. No more accepting "settlements" of pennies on the dollar for services. Because our time and profits are better these days we can afford to do more pro bono work to those in need.

[Oldchef]

It seems obvious to most of us that the most efficient solution to the health care crisis would be Medicare for all citizens. The tax increases to pay for it would be much less than we pay now for private insurance and the benefits would be enormous. Businesses would benefit from lower labor costs without having to fund insurance companies whose profit motives encourage them to deny services. Workers would be much more secure, knowing that illnesses would not bankrupt them. Insurance companies will find other profit streams to pursue.

[txkayrose]

I have been in health-care billing for several years - billing for both Medicare and private insurance, medical and pharmacy and I can honestly say that our current system is not designed to protect and support the health and wellness of the average patient. After seeing the Canadian system up-close & personal for 4 years, I can say that it has its' flaws - long waits & backlogs and practitioners with a civil-servant mentality, for starters. At the same time, no-one juggled paying for a dr's appt vs. getting groceries. Employers were encouraged to offer additional coverage as perks - dental / vision / rx coverage, covg for private rooms & elective procedures, etc.
Our population is significantly larger than Canda's and possibly more diverse. We will face some real challenges to find a way to offer coverage to everybody, but a million different, for-profit, companies,with little or no outside oversight will never be part of the solution.
Sorry BC/BS. Buh-Bye.

[anonyms]

I too have worked in health care billing and I've also worked on designing the systems for billing. I TOO have substantial experience with the Canadian system including caring for a terminally ill family member in the Canadian system. Your claim re "long waits" is just not true - the wait time for urgent and real health problems is frankly shorter than in the USA. In the US, my experience is both working and receiving care for Blue Cross, United, AND Kaiser so I have some experience here. Furthermore, the "long" wait times for non-urgent care in Canada is actually NO DIFFERENT than wait times in the USA where, for example, under private insurers, an appointment for a standard mammagram and yearly gynecological exam averages 3-4 months. The "long" wait time AMERICANS claim re the Canadian system is because AMERICANS, when going to Canada for care, WILL wait longer since Canadian citizens who actually pay into the system will receive care before the American visitor who has travelled to Canada for health care. With regards to URGENT and EMERGENT care, there is no long "wait" time. If you walk into a hospital in Canada as an American citizen with a busted knee or in labor, I can tell you from first hand experience your case is seen immediately.
Last year I filmed a Canadian nurse speaking out about this and addressing these spurious false claims: http://www.youtube.com/watch?v=2J9Qs9pszuE

[Rockerbabe]

As a healthcare practitioner in GA, I do feel your pain. The problems with trying to get any insurance company to pay out benefits in another state is almost stroke-inducing! I have a friend who took a job in England 3 years ago and raves about the British Healthcare System; he is my age (57), so he has had a lot of dealings with American Health Insurance Co and wants no part of this mess again!
I would welcome participation in Medicare, if that could be made possible for the under 65 crowd. I just want out of this BC/BS mess [my other choices are 3 different plans from Aetna, which from fellow employees comments, is not all that great either].
I just don't think anyone should get profit or bonsas from denying clients care and in some cases, the denial has caused disability and death. There should be criminal penalties for such behavior; not rewards. I do hope BHO can craft a plan and I also hope, he and his advisers will seek and listen to the words of those of us who actually do the "in the trenches" care.

[BarryS]

Try one of the other insurance companies. Then your nightmare really begins. Your real error was looking for an urgent care facility. Most places just don't operate them. Just go to a regular doctor. pretty much all of them accept BCBS anyway. I never had a problem going out-of state with BCBS, and certainly you won't either. Especially in large, advanced truly regulated states such as NY CA, etc.

I understand your desire to use Urgent Care which would actually save the insurance company money, but until they are forced to actually care for their insurees, they have no reason to use them. It is much easier to stiff an individual practitioner.

BTW, now that FLa is free of Bushes, it is time for them to reform their system. These problems always seem to be reported by someone that lives in FL or TX.

[Brian Ross - Huffpost Blogger]

Actually the Urgent Care was not my choice. Florida Blue Cross pays out for Urgent Care under my particular plan out of state, in network at a reasonable rate. Any doctor not in Florida would be considered "Out of Network" and subject to much higher fees.

[obamagirl1968]

As a former BC/BS employee, I FEEL your pain. The BlueCard System (the out of state, portable program) is a joke. If you think the customer service and provider locator service was poor, wait until you get your explanation of benefits for your processed claim; that is when the REAL nightmare begins. Good luck!

Frankly, I beleive that default health coverage should be universal, standard and non-profit (not necessarily government run but definitely federally defined standards). Because it is actually cheaper to NOT have insurance than to have a poor plan where you play premiums PLUS the out of pocket costs (co-pay, deductibles, co-insurance, non-covered services, etc.).

[Shotgun Mary]

"Because it is actually cheaper to NOT have insurance than to have a poor plan where you play premiums PLUS the out of pocket costs (co-pay, deductibles, co-insurance, non-covered services, etc.)."
I can attest to that! I recently graduated college and took a job I hate because it had heatlh insurance (thats what we're all striving for, right?) I had the good fortune of getting pregnant and actually having to use the insurance. After receiving my bills in the mail for co-pays, deductibles, etc. I started doing the math. With no insurance, I would pay roughly $78 for a full blood workup at a local private lab. (Its nice, you can walk in, order your own blood tests and pay out of pocket right there) I nearly died when I got the bill for the same test. My $78 test under insurance cost $283. I was responsible for half of that. My $78 blood test cost me $141.50 with insurance. My employer doesn't tell me what they pay for my insurance, I only know that a good chunk of my check each pay period goes towards my premiums. The employer uses that as an excuse to hold down my starting wages. All of this combined with the fact that paying a midwife completely out of pocket will cost less than having a COVERED birth in a hospital has me seriously rethinking my decision not to go to grad school . . .

[Brian Ross - Huffpost Blogger]

In some ways it can be, in other ways no. An in-network scope of your stomach, for example, here in Florida, can run about $500.00. Doctors and facilities over bill and Blue Cross over discounts until you get to your $80.00 for this and $100.00 for that. Out of the network or with no insurance, the same procedure can run $4,000 or more when you pay the doctor, facility, anesthesiologist, etc.