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[cancer] A LOT more on that billing problem - Lakeshore
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Jay Lake
Date: 2013-04-23 05:22
Subject: [cancer] A LOT more on that billing problem
Security: Public
Tags:cancer, health, oregon, personal, politics
The joys of our American for-profit private healthcare finance system continue unalloyed for me. Now I am finally naming names, after having been coy about this up until this point for the sake of professionalism.

Yesterday I received a call from the main billing office at OHSU, the hospital that has been providing me with all my cancer care since day one of this horrible misadventure. I was told that my insurance carrier, UnitedHealthcare, had ruled the 1/7/2013 visit to my oncologist as out of network, and that financial responsibility for the bill was back to me, or I was free to take it up with the insurance company further. I pointed out that I had spoken to both UHC and OHSU repeatedly, and this was a billing mismatch of some kind, probably from OHSU's end. I further pointed out that on the same damned bill they'd just sent me, later visits to my oncologist were correctly billed in-network. The OHSU billing rep was professional but not particular nice about this, reminding me they were giving me a courtesy call. I said the courtesy had gone out of this process a long time ago.

After we got off the phone, I tallied my contact notes on this issue in a spreadsheet. Counting yesterday's calls (including a brief callback from the billing rep), I have placed or received sixteen separate phone calls on this matter, and with transfers spoken to or left voicemails for twenty-five people. (Note that some of those were multiple contacts with the same person, so that's actually eighteen different people.)

So I opened complaints with the Oregon Attorney General's Consumer Protection Division, as well as the Oregon Insurance Division. I also spoke to someone from the Joint Commission, that handles hospital accreditation, but they only review medical practice issues, not business issues. Finally, thanks to help from a friend, I also emailed a state senator who used to be a physician in practice at OHSU.

The email I sent the senator about sums it all up, so I'm reproducing the main body of the message here, with only the greeting redacted:
I am having an intractable problem with OHSU, specifically on the business side of the house. I am a late stage cancer patient, incurable, transitioning to terminal status. I have been seeing my oncologist at OHSU since 2009. I have had five major surgeries and over 1,500 hours of chemotherapy, all of that except the first of the surgeries under their care. On my 1/7/2013 office visit, my insurance company, UnitedHealthcare (UHC), classified my oncologist as out of network, despite their having always been in network. This resulted in much higher billing fees to me, $283.59 instead of my $40 office visit co-pay.

After multiple phone calls, I determined that OHSU had changed my oncologist’s billing address. This created a data mismatch between the hospital's billed zip code and the insurance company's in-network provider database.

In the three months since, I have spoken or left voicemail for 25 people across 16 phone calls to both OHSU and UHC. They are completely unable to resolve this billing data mismatch, even though both prior and subsequent visits to my oncologist have been correctly billed as in-network. I was told this morning (4/22) by OHSU that it was an insurance company problem and they could not resolve it. I have been told repeatedly by UHC that this is a billing problem and they cannot resolve it.

I cannot fix this. I have no power over OHSU billing process or UHC’s claims process. In the last months of my life, I am spending many hours on the telephone pursuing this matter which apparently cannot be resolved from either end, resulting in me being held responsible for out of network charges.

While the amount in question is small, and I am by no means destitute, I should not have to pay this. I am covered by an employer sponsored plan, my oncologist is in network on my insurance policy; that should be the end of it. And the process has frustrated me sufficiently to make me want to continue to maintain the principled stance I have already taken.

As of today, I have opened complaints with the Oregon attorney general’s consumer protection division, and the Oregon insurance division. I’m not sure either of these is going to have any effect. I was hoping you might be able to direct me to a suitable path of management escalation within the OHSU organization, either in your capacity as a physician who has practiced there, or in your capacity as a state senator.

I can provide call logs documenting every conversation with OHSU, along with billing records from OHSU and claims management documents from UHC, as needed.

Thank you.

The basic problem is, of course, no one in authority at either OHSU or UHC has any particular motivation to fix this. The problem just goes around in circles at low levels and keeps getting referred back to me.

This is precisely what is wrong with our current healthcare finance system. The Affordable Care Act (Obamacare) only does a very partial job of fixing these kinds of problems. Civilized, humane societies with single payer systems don't create this kind of hassle and heartbreak for their sick and dying. I'm a pretty articulate guy with good social and professional resources, and this is a small piece of billing. Imagine my position if the billing were substantial, one of my $100,000 surgeries, or if I were confused and baffled by paperwork and unable to untangle the repeat billing trails.

This is wrong. I wish the conservatives in this country who have opposed the process of healthcare reform were capable of the kind of empathy and understanding that lets them see past their ideological blinders to the hard reality of the system they so blithely support. And I fervently hope for their sakes that they never have to go through what I am going through. Self-evidently, their suffering means a great deal more to me than mine means to them.

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W. Lotus
User: wlotusopenid
Date: 2013-04-23 12:54 (UTC)
Subject: (no subject)
If them going through what you are going through is what it takes for them to get out of the way of true healthcare reform in this country, so be it.
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a_cubed
User: a_cubed
Date: 2013-04-23 13:10 (UTC)
Subject: (no subject)
The trouble is, a we've seen with other issues such as gay rights, only the ones who actually go through it themselves have a "Paulene Road to Damascus moment". All the rest of their cohort then close ranks against the apostate, claiming they've been polluted somehow.
Rather reminds me of Iain (no-M) Banks' Complicity. One-shot revenge (bythe universe) unfortunately doesn't change the minds of the larger movement - if it could they wouldn't be there in the first place. I suspect US politics is now progressing one funeral and one birth at a time. Luckily, the births are on the side of progress and the deaths are on the side of reactionism. Just hope the reactionaries don't develop a true scorched earth policy before there are too few of them to take the system down.
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W. Lotus: Exorcism
User: wlotusopenid
Date: 2013-04-23 13:13 (UTC)
Subject: (no subject)
Keyword:Exorcism
Yes, you are quite right.
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a_cubed
User: a_cubed
Date: 2013-04-23 13:17 (UTC)
Subject: (no subject)
Unfortunately.
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Amy Sisson
User: amysisson
Date: 2013-04-23 13:34 (UTC)
Subject: (no subject)
Not that you need another headache, but I wonder whether small claims court might work, at least in recovering the $283.59 plus some hourly amount for all the phone calls. They may still claim they can't fix the problem, but perhaps you can make them pay for their inability to fix the problem. I also have the sense (rightly or wrongly) that small claims courts like to factor in, oh, common sense.

Again, probably too much paperwork and hassle, and you'd probably have to pay the $283.59 first, but boy, I'd love to see them publicly declared as the morons they are, and forced to pay.
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Karen
User: klwilliams
Date: 2013-04-23 15:55 (UTC)
Subject: (no subject)
If you go this route, be sure to name everyone in whatever management team or board runs the hospital, so they'll need to respond in order to win. (They won't, so you'll win.) Then be sure to go to the newspapers so they'll report on it.
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russ
User: goulo
Date: 2013-04-23 13:44 (UTC)
Subject: (no subject)
Bravo, and thanks for going the distance to try to fix that time-wasting cruel bureaucratic inanity. I will not be surprised to see your efforts bear fruit soon.

And yeah, I shudder to think about people without your verbal and paperwork skills stuck in these situations.
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Karen
User: klwilliams
Date: 2013-04-23 15:53 (UTC)
Subject: (no subject)
I hope at least two thirds of them go through what you're going through. That's the only way this will change, when they feel the same pain you do.
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martianmooncrab
User: martianmooncrab
Date: 2013-04-23 18:57 (UTC)
Subject: (no subject)
You had way more patience than I ever would. I would have lost it by call 3 and unleashed hell upon them.
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Jenny Rae Rappaport
User: eiriene
Date: 2013-04-23 19:44 (UTC)
Subject: (no subject)
I feel your pain regarding United Healthcare. Due to a random error on their part this fall, my daughter and I were classified as having UHC as secondary insurance, while my husband remained in their system as primary insurance.

UHC was and is the primary insurance for all three of us.

This, in turn, has caused every single doctor's bill to bounce back to us for payment, since UHC refused to cover it. I have been on the phone with them multiple times and have theoretically resolved this, as I'm no longer getting bills bouncing to me for payment. But the time and the frustration I can NEVER get back.
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User: lindadee
Date: 2013-04-23 21:26 (UTC)
Subject: (no subject)
How did we come to this state of medical care. When I had my appendix out about 30 years ago (living in New York City), even though for most things my insurance paid only 80% of my coverage, I didn't pay a dime. I was in the hospital eight days (around the Thanksgiving holiday).
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Matthew S. Rotundo: Radioactive
User: matthewsrotundo
Date: 2013-04-23 21:34 (UTC)
Subject: (no subject)
Keyword:Radioactive
The basic problem is, of course, no one in authority at either OHSU or UHC has any particular motivation to fix this.

Well, the OID has authority over UHC. If OID tells them to fix the damned problem, they have to fix it.

OID has no authority over OHSU, though.

I think you're going about this the right way. It's absolutely ridiculous that this hasn't been resolved yet. Unfortunately, I see this kind of incompetence all the time. Once one thing goes wrong, the errors just keep cascading in a snowball effect.

Have you given any thought to approaching the media?
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Jay Lake
User: jaylake
Date: 2013-04-23 21:37 (UTC)
Subject:
Well, the OID has authority over UHC. If OID tells them to fix the damned problem, they have to fix it.

Precisely why I went to OID, and the state AG. Those are people who have the power to motivate a fix.

And yes, the media is a possibility. Remember, the last customer service dispute I got into wound up on CNN, and will soon be featured again in a major media outlet. I prefer to hold onto that particularly flyswatter a little longer.

Edited at 2013-04-23 09:37 pm (UTC)
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Msconduct
User: msconduct
Date: 2013-04-23 23:31 (UTC)
Subject: (no subject)
Civilized, humane societies with single payer systems don't create this kind of hassle and heartbreak for their sick and dying.

That's true, they don't. It's utterly inhumane. I can't imagine dealing with the financial stress of treatment on top of a serious diagnosis like cancer.

But they do create other kinds of hassle and heartbreak. You don't get to have whatever treatment you like: you get what they give you. Increases in demand for radiation therapy in NZ, for example, means there are significant delays in getting timely treatment. Also, if a drug is too expensive, it's not available, and that's that. A friend of mine who constantly sprouts melanomas is taking a new drug which is saving his life. But a four-dose course costs $160,000. The drug is currently being provided free by the drug company, but as soon as they apply for registration, that will be withdrawn. It's unlikely it will be approved because of the extreme cost, and of course my friend can't afford to pay for it himself.

Even things like screening which Americans take for granted is missing from our system. The standard for bowel cancer screening in the US is colonoscopy at 50: in contrast, in NZ we have no bowel screening programme at all. If I want a colonoscopy for screening, the government won't give it to me and my private insurer won't pay for it either unless I have symptoms.

The financial side of the US system is a huge, enormous, overpowering drawback. But medically I would feel safer in your system.
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a_cubed
User: a_cubed
Date: 2013-04-24 01:06 (UTC)
Subject: (no subject)
One of the myths that supports the US broken system is that it's medically better than elsewhere. No, it's not. For a small proportion of people they may have better outcomes but statistically, their outcomes are at or below the OECD average when taken across patients (and for a bunch of stuff, those without insurance never become patients because they have no coverage and no way to get treatment, so even these broad equivalences may be reporting the US higher than reality.
Remember, Jay is one of the lucky ones in the US system in that he has reasonably good cover, though even in those circumstances as his original post above shows there are significant problems that can arise - in this case if he was too sick to deal with it and his family too distracted the $250 wouldn't do them significant harm, but this could easily have been $100,000 for his liver surgery instead of one office visit to the oncologist.
All systems of healthcare have rationing somewhere. There's always someone who can't get the treatment that might help (remember, particularly in cancer it's still almost all statistical).
In similar circumstances in the UK, there are special case review processes on offer. The general justification for not allowing drugs to be prescribed is that the chances of favourable outcomes are insufficient to justify the spending. However, if your friend has been responding well to the treatment, in the UK that would be regarded differently and MIGHT then be allowed.
Of course the cost of some of these new treatments is itsel a separate scandal. Yes, some of these treatments are expensive to develop, but already a lot of that is funded by the public purse and the drug companies are claiming they take lots of risk and deserve huge rewards when in reality they take as few risks as possible, game the system like mad and privatise the profit while socialising the risks and losses.
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Msconduct
User: msconduct
Date: 2013-04-24 03:04 (UTC)
Subject: (no subject)
I think NZ is perhaps worse off in this regard than the other rich OECD countries because we're funding medical treatment from a tiny population base (~4 million). I know the UK is far more generous in many respects. Even Australia is much better off than we are: our government often sends cancer patients to Australia for treatment when timely treatment isn't available here. The agency that controls what drugs are available, Pharmac, is notorious worldwide for screwing suppliers down on price, to the extent that the US has attempted to make a fair trade agreement contingent on a loosening of this.

Despite the drawbacks of our system I would still pick it every time. No system is perfect, but the cruelty of the US system is simply intolerable.
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dionysus1999
User: dionysus1999
Date: 2013-04-24 16:43 (UTC)
Subject: (no subject)
I hear similar stories from patients WAY too often. A single payer system that works like Medicare would be awesome from where I sit.
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Lethran: Angel
User: gwyd
Date: 2013-04-25 03:55 (UTC)
Subject: (no subject)
Keyword:Angel
This sucks. I hate that we don't have single payer like civilized countries and you shouldn't have to deal with this bullshit at all.
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Nat S Ford
User: natf
Date: 2013-04-25 23:51 (UTC)
Subject: (no subject)
Permission to share/repost this on my LJ?
While we complain about the NHS occasionally, I am SO glad we have it there here in the UK.
*hugs*
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Jay Lake
User: jaylake
Date: 2013-04-26 00:00 (UTC)
Subject: (no subject)
Feel free!
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Nat S Ford: links
User: natf
Date: 2013-04-26 02:42 (UTC)
Subject: (no subject)
Keyword:links
Thank you. Done!
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LiveJournal: pingback_bot
User: livejournal
Date: 2013-04-26 02:41 (UTC)
Subject: "[cancer] A LOT more on that billing problem"
Keyword:pingback_bot
User natf referenced to your post from "[cancer] A LOT more on that billing problem" saying: [...] are SO lucky to have the NHS! Originally posted by at [cancer] A LOT more on that billing problem [...]
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Follow me... I'm a GEOGRAPHER!: Caged butterfly
User: elyssa
Date: 2013-04-26 03:46 (UTC)
Subject: (no subject)
Keyword:Caged butterfly
I wanted to pop over here from natf and just say that I understand your pain and applaud your stance here, even if your personal situation puts all of my medical problems to shame. Your calm and even eloquent approach to a no-win situation is awing and humbling.
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Jay Lake
User: jaylake
Date: 2013-04-26 13:38 (UTC)
Subject:
Thank you.
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Agent Mimi
User: agent_mimi
Date: 2013-04-27 13:28 (UTC)
Subject: (no subject)
I am so sorry. I had UHC as my insurance for several years, and my experiences were not pleasant, so I can imagine (on a much smaller scale) what you're going through.

My mother's insurance was exceptional, and she was lucky to be a nurse and friends with the insurance processor in the medical office. Because mom's boss had been so horrible to her during the ordeal, the insurance processor went above and beyond to make sure everything was paid by insurance. It was an enormous amount of work. Everyday people who don't have that kind of connection are screwed. I hope you get some swift resolution with this, and I think you were more than justified in sending those complaints.
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