Battered by Health Insurance

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May 1, 2008 10:52 a.m.

I spend a lot of time measuring the costs of the current health care system, mostly in counting the broken families that end up in bankruptcy. For families hit with medical bills they cannot pay, the current health care system magnifies their pain. But even those who have health insurance and can afford to pay are knocked around in a broken system. A friend — with insurance — had some minor surgery a while back. She bounced back quickly, but the pain of trying to pay is still not over:

I got a letter from the hospital very nicely demanding payment of over $500 today. The hospital thinks I owe them $438 more than I actually owe them because the insurance company sent that amount to the doctor. The doctor, of course, won’t send it to the hospital. Instead, I had to call the insurance company to ask them to recall the payment so they can then send it to the hospital.

If I fax the explanation of benefits to the hospital, they won’t turn my account over to collections (that, despite the fact that I have already paid $300 and call them about once a week to work on this problem.) And most amusing is the fact that the doctors’ group and the insurance company are managed by the same company.

You cannot imagine how much effort has gone into figuring out what I actually owe. I have never received (despite repeated requests) an itemized bill from the hospital. I only made it this far by talking for 20 minutes to the supervisor of the billing department! He’s the one who figured out that the insurance company had denied the claim for all the injections I received while in surgery. I called the insurance company last month and they fixed this, but sent the payment ($438) to the doctor instead of the hospital.

Complicating this is the fact that the hospital keeps a running total of all amounts due, so the fact that I had another expense (bone scan) makes it hard to keep the surgery bill separate.

And the doctor’s billing department just billed me for a co-pay that I already paid (“We’re working on that problem” she told me!!) There are now four doctors’ bills involved:
1. the surgeon, who was paid in full;
2. the anesthesiologist, who was paid in full;
3. the doctor who saw me for the follow-up visit (who was paid, and I paid the copay, which was lost and now found) and
4. the radiologist for the bone scan.
5. Oh! I forgot, and the pathologist from the surgery!!

So today I figured out that I owed only $2.30, to the pathologist (somehow that was my copay!) and about $98 to the hospital after they track down the payment that went to the doctor.

How on earth would a sick person work through this mess? And how would a person who couldn’t take an hour a week off for 6 weeks to deal with this ever get payments straight? The worst part is that I am incredibly lucky to be in this situation because I have health insurance.

This isn’t about getting more health insurance. This is about a system that is broken even for those who have health insurance. This is about waste and inefficiency and burning up dollars that should go to medical treatment. Where are the serious proposals to cut through this nonsense and waste?

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