Here's to Your Health (Insurance) - 2010

As the healthcare debate rages, and reforms are STILL not forthcoming, I reprint here, for you reading pleasure, an updated essay from several years ago. I am sorry to report that not much has changed since I wrote it.

Here's to Your Health (Insurance)!

Recent debates over health care remind of how little things have changed in the past few years. It makes me think back to a time when doctors in my home state of New Jersey and other states conducted work stoppages because they wished to protest their ever-increasing malpractice insurance premiums. Many claimed that these high fees were jeopardizing their ability to practice medicine. Personally, my gut reaction was to say I think it really interferes with their ability to play golf, but that would certainly be unfair. Lots of doctors play tennis.

Oh I sympathize with the beleaguered medical profession. No one can continue to pay ever-increasing fees, especially in today’s economic climate. What bothered me, then, and still bothers me, was that patients were expected to support the doctors in their actions, under the threat of thousands of doctors fleeing the state or abandoning the practice of medicine altogether. Somehow, the patients were dragged into the fight and placed squarely in the middle between the doctor and an insurance company. This is a bad habit that the whole medical insurance system has gotten into, and it still goes on today. 

It all started with HMOs, those “health maintenance organizations” who sold us a bill of good disguised as affordable health care. What we really got was a draconian system of delay and defer tactics, reams of paperwork, and a bill from the doctor stating that he can’t wait any longer for your insurance payment and besides, you signed a form stating that you would pay any balance due. Of course, the HMO, who has lost the original paperwork, then denies payment based on the 30-day rule — if they can lose your paperwork for 30 days, they don’t have to pay the bill.

So you call the doctor about the missing paperwork, and suggest that someone from the doctor’s office call the insurance carrier and discuss it. The office staff refuses, claiming that only patients can call the insurance company, they are much too busy sending out bills and they remind you that YOU ARE RESPONSIBLE if the insurance company doesn’t pay. So you call the insurance company who reiterates, WE DO NOT HAVE THE PAPERWORK. Meanwhile, a lovely collection of weekly billing notices begin to pile up in your house, each one in a more vibrant color than the previous one, each one demanding payment, from YOU – THE RESPONSIBLE PARTY. Eventually, a letter comes from the insurance company. They have gotten the bill! Unfortunately, the doctor’s bill and mysterious diagnosis code is insufficient, could I please send a written explanation of why I (or my child) required this doctor’s services? This, of course is followed by the requisite losing of the letter and remailing of the letter procedure, followed by a repeat of the THIRTY DAYS HAS GONE BY letter — the end result being, the bill is unpaid, and the doctor has now turned it over to his lawyer. No one stages a protest, has a work stoppage or even writes a terse letter over YOUR insurance troubles. You are left one your own, smack dab in the middle between the medical profession and the insurance company. 

Not long ago, I had a bill for services that has been ping-ponging between me, the medical provider, the insurance company and several layers of lawyers and collection agencies for FIVE YEARS. I was no longer employed at the company that provided the medical insurance, and that company no longer used that insurance company. Surprisingly, there were many complaints about unpaid medical bills. Another time, a bill for my daughter was paid on a timely basis; however, the check was sent to a hospital instead of the doctor. The hospital, not wishing to interfere, promptly cashed the check, and set up an account with a credit balance under my daughter’s name. The fact that my daughter had never been a patient at that hospital was apparently unimportant. When I finally tracked the payment down and called the hospital, they refused to refund the money. After all, the insurance company had sent it to them. Only a certified letter from the insurance carrier demanding the money back would result in the hospital issuing a refund. Do you think either the insurance company or the hospital would call each other to correct the error? HA! As the patient (or parent of the patient as the case was) I had to call each entity and transfer messages back and forth to them. I felt like the child in a dysfunctional divorce, carrying messages between parents who refuse to speak to each other. 

And of course, you know what else was happening during this time. The doctor was sending me bills for payment reminding me that I WAS THE RESPONSIBLE PARTY and that my failure to meet my obligation was going to result in the matter being referred to a collection agency.

All I can say is, get in line, there are ten doctors ahead of you.