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Lakeshore - [cancer] Best healthcare system in the world, my tumor-riddled ass
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Jay Lake
Date: 2013-02-06 05:02
Subject: [cancer] Best healthcare system in the world, my tumor-riddled ass
Security: Public
Tags:cancer, health, personal. culture, politics
One of the drumbeats from our friends on the Right here in the United States is that Obamacare is some kind of socialist plot to undermine the best healthcare system in the world.

Only someone who has never been enmeshed in American healthcare could say that. Our treatments and outcomes are generally pretty good — though not always, viz our infant mortality rates, for example — but the healthcare billing and payments structure is a bleeding nightmare.

I discovered last week that my medical oncologist, whom I have been seeing since 2009, is suddenly being classed as out-of-network by my health insurance carrier. This means instead of my $40 specialist co-pay, I am responsible for $283.59 for seeing an out-of-network provider with each of my biweekly visits.

This has still not been cleared up, but to date I have made or received ten phone calls to either my insurance carrier or my treating hospital, and with transfers, spoken to or left voicemails for seventeen different people. I have discovered that my hospital has multiple departments known as "managed care", and multiple departments known as "billing", and that even the people who work in those departments cannot tell me the difference, or necessarily know what to do if my call has been accidentally transferred to the wrong department.

Meanwhile, my doctor clearly shows as in-network on my insurance carrier's own "Find a Physician" web site. Yet when I call the claims group, they tell me my doctor is out-of-network.

Because reasons.

It turns out the problem is actually that on 1/1/2013, the address of record for my doctor changed from one of my hospital's multiple street addresses to a different street address. This caused the tax ID under which they bill to be different. Apparently, my hospital's billing department (or one of them, at least), has not yet caught up to this little factoid.

Meanwhile I, the stressed out and distracted late stage cancer patient, am responsible for talking to at least seventeen different people to get this straightened out. The hospital isn't doing it because they get paid either way. The insurance carrier isn't doing it because by billing out-of-network they save money. It all rests on me. Another part of the fundamental cruel illogic of our social system.

I have spent more time on this problem than I spent talking to my oncologist about the fact that my cancer is now considered incurable. Think about what that says about our systemic priorities.

To put it all in simple terms, in a single-payer system, none of this would be a problem.

So you think this is the best healthcare system in the world? Walk a mile in my shoes, then say that. On the pointy end, where medicine is practiced, I have very few complaints. But the ridiculous for-profit payment processes can be a freaking nightmare.

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rarelylynne
User: rarelylynne
Date: 2013-02-06 14:40 (UTC)
Subject: (no subject)
::nods:: Yup. The billing system is completely designed to "prevent fraud" which means that it's borked beyond recognition.

Our favorite example: our insurance company's subcontractor for wheelchairs initially denied us the seat on Caitlin's wheelchair because it wasn't "medically necessary." O_O
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Skellington
User: skellington1
Date: 2013-02-06 16:47 (UTC)
Subject: (no subject)
Oh lord, I'm going to add that to my list of the best stupid insurance stories. My own top contribution to that list is the time when my insurance company easily agreed to pay for the initial surgery and all the appointments for the ilizarov device, but then refused to pay for the surgery to take it out eleven months later.
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cathshaffer
User: cathshaffer
Date: 2013-02-06 15:11 (UTC)
Subject: (no subject)
This is actually primarily your medical oncologist's problem to sort out. Have you talked to his office? Insurance companies have separate customer service lines for patients and providers. The people that man patient customer service lines don't have any real information or authority to resolve problems in reimbursement to providers, so the most important communication to focus on is with your actual provider. The medical oncologist should be concerned that there is an error in the system that is keeping them from getting paid, and they have access to channels at the insurance company that you don't. Another tip I have is that it can be surprisingly useful to just wait. This glitch sounds like the sort of thing that may resolve spontaneously when someone updates a database. Maybe not...but it would certainly keep until the next billing cycle. Good luck, and I'm sorry for the aggravation.
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Jay Lake
User: jaylake
Date: 2013-02-06 15:23 (UTC)
Subject: (no subject)
Contact seventeen was actually someone at the hospital who took this on, so, yeah...
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cathshaffer
User: cathshaffer
Date: 2013-02-06 15:27 (UTC)
Subject: (no subject)
Oof. My doctor shares building with half a dozen or so offices, all in the same network, sharing a provider code. They have a person hired full time to do nothing but deal with this crap.
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Andrew Trembley
User: bovil
Date: 2013-02-06 17:27 (UTC)
Subject: (no subject)
My dentist stopped doing direct insurance processing. You pay in full, the office does submit your reimbursement request, but the amount they save on collections and admin staff... I know what my visits cost, and it's not ridiculous.

My optometrist only deals with one insurance provider. Anyone else, you're out of luck, and have to file your own reimbursement requests.

I'm glad my healthcare is with Kaiser. Sure, they're a mess, but they're less of a mess than everything else.
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mcjulie
User: mcjulie
Date: 2013-02-06 15:31 (UTC)
Subject: (no subject)
Something that became really obvious to me during the Bush II era -- during the holy glow of hist post-9/11 90% approval ratings -- is that people very often latch onto the narrative that comforts them best, not the narrative that explains the data best. People believed he was a great leader in that moment because they needed to believe it, in spit of already abundant evidence to the contrary. (such as, the fact that 9/11 happened at all.)

Our brains run on magic. On some level, whether we admit it or not, we obviously think that believing in a thing really super-duper hard makes it true.

But, as with Bush II's greatness, when the narrative is too far from the facts, eventually people start to come around. Obamacare happened, Hillarycare didn't.

But, also as with Bush II's greatness, some people will never come around, and the accumulating cognitive dissonance just makes them more and more stubborn.

Oh, and I'm so sorry that you have to deal with all this on top of everything else.

Edited at 2013-02-06 03:32 pm (UTC)
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fledgist
User: fledgist
Date: 2013-02-06 15:57 (UTC)
Subject: (no subject)
This, as they say.

This is, after all, the land where medical coding mistakes can create such wonders as the female prostate.
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Keikaimalu
User: keikaimalu
Date: 2013-02-06 16:11 (UTC)
Subject: (no subject)
I'm sensing a new career opportunity: patient insurance advocate and wrangler. Hire them to sort through these insurance and payment issues. And then, of course, pay them too. So does our medical system become more labyrinthine.

In seriousness, I do hope you have people to help you with this -- friends, family, etc. It really seems like an unspeakable burden to place on someone already dealing with such heavy medical issues.

Time to call Michael Moore. Oh, wait....

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Chris McKitterick: Bush dollar
User: mckitterick
Date: 2013-02-06 16:53 (UTC)
Subject: (no subject)
Keyword:Bush dollar
This is just so much crap piled on top of you at an already awful time. I'm so sorry to hear about how everything's going right now, Jay.
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Kari Sperring
User: la_marquise_de_
Date: 2013-02-06 17:29 (UTC)
Subject: (no subject)
That is ridiculous.
I am so sorry you're having to deal with this as well.
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User: nicosian
Date: 2013-02-06 17:44 (UTC)
Subject: (no subject)
Gah. How aggravating.

Speaking on the side of the evil socialist boogeyman of healthcare...I love it. I spent a morning at my high risk OBGYN's office, with various members of the team in consult, and bloodwork, all done on site seamlessly and no haggling with any middle man be it insurer or government.

Bloody honest truth, the gov doesn't do half the scary stuff that is attributed. We have wait times that vary, but my husband got an mri in 5 days, from seeing his GP to the scan. We've got it damn good for the princely sum of well, taxes that aren't all that different than US colleagues.

Its been a lifesaver this pregnancy, and a great weight off my shoulders when I'm ill equipped to wrangle things. Our private insurance for prescriptions has been just as painlessly uncomplicated.

Do we have fraud? On the doctors side billing wise time to time, but no one generally "abuses" the free care for a laugh. We have some wait times, but over my adult life they've gotten drastically shorter. We do have an aging population and a lot of rural folk that have to travel to larger centers for more special care but I gather that's the same in the US.

Single payer, in my view, is the only humane way to do this. I wish it were so for you.
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User: lindadee
Date: 2013-02-06 17:52 (UTC)
Subject: (no subject)
Just a thought, Jay, but have you considered writing an op ed piece about this for any of the major newspapers? You would be a voice for many who can't speak as eloquently as you.
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russ: quo vadis
User: goulo
Date: 2013-02-07 08:33 (UTC)
Subject: (no subject)
Keyword:quo vadis
Excellent suggestion. Jay is a very effective writer, and this being a personal story would make it a good strong article for wider circulation. I think it would enlighten many people and probably help change some minds and be a step toward improving the healthcare system.
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martianmooncrab
User: martianmooncrab
Date: 2013-02-06 18:10 (UTC)
Subject: (no subject)
by billing out-of-network they save money

they actually make money.. any money not paid out is earned money.. most companies live off the interest paid on The Float. Its like kiting checks.

Maybe you should start charging them a consultants fee for solving their problem.
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shelly_rae
User: shelly_rae
Date: 2013-02-06 18:46 (UTC)
Subject: (no subject)
I can't figure it out but I have the excuse of brain damage. I cannot image how people with less ability to cope than you or I manage at all. There's supposed to be a social worker or case worker helping me but I haven't heard from them, ever. I guess they came into ICU but I don't know.
It's frustrating and I see how easy it is even for people with good health care benefits to go bankrupt. My perfect credit rating was ruined by medical bills that insurance should have covered. The hospital sent the bills to collections agencies--just try and get those settled. Better health care exists in a great many places with better access to meds, spinal care, and well, help.

I don't have enough time in my life left to sit on the phone with insurance. Fie.
Anon
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Debbie N.
User: wild_irises
Date: 2013-02-06 20:29 (UTC)
Subject: (no subject)
Shelley Ray, I would be glad to help you from a distance.
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Debbie N.
User: wild_irises
Date: 2013-02-06 20:32 (UTC)
Subject: (no subject)
And Obamacare is slowly but steadily being borked the same way, witness the recent decision to figure in only the cost of an individual's care and not a family's care in setting minimums, and also this.
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Angie
User: aiela
Date: 2013-02-06 22:08 (UTC)
Subject: (no subject)
Off topic, but I thought you might find this interesting, given your own posts on the topics of sex and cancer:

http://www.cnn.com/2013/02/06/health/sex-cancer-clinics-programs/index.html?hpt=hp_bn13
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Jay Lake
User: jaylake
Date: 2013-02-06 22:18 (UTC)
Subject: (no subject)
Thank you.
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Natalie S Ford: british
User: natalief
Date: 2013-02-09 18:43 (UTC)
Subject: (no subject)
Keyword:british
I am obviously biassed and hate that you have to deal with this but I would say that the US has some of the best medical practitioners/doctors in the world but that the UK has the better medical "system".
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