The health insurance industry is sick
Three members of my family have had surgery in the past 14 months, and it’s been one harrowing ordeal after another.
Not the surgery. My gall bladder was plucked out while I slept, my wife’s knee is coming along, and my daughter’s tonsils have entered into Eternal Rest at the Lockwood landfill. (Actually I don’t know that; it never occurred to me to wonder what they do with old tonsils.)
The harrowing part has been the billing.
Not the paying, which I’ve tried to do and thought, several times, that I’d done. What’s beaten me down is understanding the bills, keeping them straight and explaining to insurance carriers for the third time that we’ve already had this conversation and determined that yes, the procedure is covered, and no, my wife doesn’t have her own insurance and yes, my daughter is a full-time student, just as she was when I told you last month she was a full-time student.
Then we send the money anyway because the bills start coming with threats, and then, weeks or months later, a check will arrive from the “provider” with a cursory explanation: “Refund of overpayment” or “Reimbursed by carrier” or something.
A figure you read a lot is that one-third of the money spent on health care in the United States goes for administration. I believe it. I’ve thrown away stacks of paperwork in several fits of pique, so I can’t give specifics or name a worst offender (good news for the former Washoe Medical Center, I suspect), but I know that one procedure resulted in 17 bills in five weeks.
Full disclosure: I often stall on the first round because I figure the insurance company may Do Right. When I get a bill reflecting it has done that, I’ll come across with my portion.
That used to work, but in recent years, not so much. Physicians have told me insurers are increasingly slow to pay, and I know from experience that some reflexively deny even covered expenses. My wife made three phone calls recently to challenge rejected claims and recovered, like magic, nearly $2,500. The parasites didn’t even argue. When she said, “Why wasn’t this paid?” they folded like origami. But if one person out of, say, 20, doesn’t call, it’s gravy.
Here’s another gripe: multiple bills for what is, to the patient, a single procedure or service. Six or seven months after I waved goodbye to my gall bladder, we got one (a bill, not a gall bladder) from Nevada City, Calif., with no information but my name, the payee’s name and address and an amount, $236.
We’d had a blizzard of bills from several sources, and I meant to ask for an explanation of this one but put it off. In about three weeks I got another, with the amount reduced to $150. I put that aside, and in a few weeks came another, marked “discounted” to $80-something, still without details. I’m thinking if I hold out, maybe the guy will send me money.
More than that, though, I’m thinking this: Why does this have to be so complicated? The goal here shouldn’t be to enrich insurance companies or provide yachts for surgeons (not that they shouldn’t have yachts; I want anybody who goes under my hood to be relaxed, well-compensated and happy). Ideally, our medical system should provide care for people who need it at prices people can afford. More and more, it looks like the only way that can be done is with one giant entity, run or strictly regulated by government, driving the bus.
If that conflicts with your ideology, give thanks that you’ve stayed healthy.