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[cancer] Healthcare Weirdness - Lakeshore
An author of no particular popularity

Jay Lake
Date: 2011-05-12 05:46
Subject: [cancer] Healthcare Weirdness
Security: Public
Tags:cancer, child, family, health, healthcare, weird
A decent chunk of my free time yesterday was consumed in pursuing insurance paperwork. The tangle between deductibles, out of pockets and co-insurance is deep and strange. Deeper and stranger still is the relationship between billers, billing codes and insurance carriers. Meanwhile, my time as the patient is spent playing telephone, literally and figuratively, between the hospital and my insurance company.

First of all, I have to meet my deductible. After my deductible, I have to meet my co-insurance target of 10% of allowed billing per procedure. That runs up to my out-of-pocket expense limit, except, of course, for those things which do not count toward my out-of-pocket expense limit.

Clear so far?

Then there was the problem of two of Mother of the Child's bills. For preventative care. Which is supposed to be covered for the full amount, not applying to the deductible, co-insurance, or out-of-pocket expense limit. Except when it's not covered. Because, say, MotC saw a resident instead of a staff physician. (We get our healthcare from a major teaching hospital with associated clinics.)

It turns out that when you see a staff physician, the billing code the insurance company receives is associated with that doctor's Tax ID number, and is processed as a consultation with a physician. When you see a resident, the billing code the insurance company sees is a clinic services code, because residents don't yet have Tax ID numbers, and so it is processed as a clinic service.

Physician consultations for preventative care are covered in full. Clinic services are subject to deductible, co-insurance, and out-of-pocket expense requirements. The net result is that I or MotC or [info]the_child can see a fully accredited staff physician for no cost to us whatsoever, or we can see a resident — ie, a brand new doctor still in training — and pay about $115 for the privilege of being seen by a far less experienced doctor.

All because of billing codes.

What? The? Fuck?

The response of the hospital billing department? "Well, yes, that's how it works. In the future you'll need to be prepared to pay the deductible amount for seeing a resident."

Me: "So what you're saying is if I don't want to spend $115, I need to insist on a staff physician appointment."

Hospital billing department: "Well, yes."

Me: "That is some really screwed up customer service." (Not to mention some screwed up physician training priorities.)

Hospital billing department: "That's how it works, sir."

Nope, the healthcare financing system in this country doesn't need any fixing whatsoever. Nosirreebob. Only a Socialist could think there was anything wrong with this.

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W. Lotus
User: wlotus
Date: 2011-05-12 12:52 (UTC)
Subject: (no subject)
In that case, I must be a Socialist. *headdesk*
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ubiquitous_a: eddie-cakeordeath
User: ubiquitous_a
Date: 2011-05-12 14:05 (UTC)
Subject: (no subject)
Keyword:eddie-cakeordeath
Well, it might be a good time to consider moving to Vermont. Cause, single payer, yo.
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ubiquitous_a: eddie-cakeordeath
User: ubiquitous_a
Date: 2011-05-12 14:07 (UTC)
Subject: (no subject)
Keyword:eddie-cakeordeath
Speaking of which, I wonder if their will be a massive tidal wave of people moving to VT once they get that passed. It sure would speak volumes about what people really want and need, versus the nonsensical politics about "socialism".
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e_bourne
User: e_bourne
Date: 2011-05-12 14:10 (UTC)
Subject: (no subject)
I'm happy to be a socialist. We ran into similar situations with Mark.

It may be possible for you to talk with someone within your company's HR and get some advocacy there. It depends on the company -- I purchase health insurance for our company and when our employees have problems as you've outlined, they come to me and I go to our rep and make loud noises to help get a resolution. Because insurance is purchased every year and they are competitive. They don't want to lose even a small company like us. So it -may- be possible that there's someone in your HR department who would help advocate for you on some of these things. Every company is different, so maybe not. It's just a thought.
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Jay Lake
User: jaylake
Date: 2011-05-12 14:18 (UTC)
Subject: (no subject)
I almost went to HR yesterday, but eventually it all worked out. Still weird...
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John
User: djonn
Date: 2011-05-12 14:39 (UTC)
Subject: (no subject)
Strictly speaking, this is less a problem with health care finance (which is to say, the cost of the care itself) than it is a problem with the claims process and/or the provider's administrative practices. Fixing this particular problem (or class of problems, as your situation is certainly not unique) ought to be possible within the framework of the existing health care system, and a fix ought in itself to encourage better and more efficient use of health care resources.

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Jay Lake
User: jaylake
Date: 2011-05-12 14:41 (UTC)
Subject: (no subject)
It's a problem with healthcare finance not in the sense of cost, but in the sense of payment processes. (Which is pretty much what I mean when I talk about healthcare finance.)
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A large duck
User: burger_eater
Date: 2011-05-12 15:38 (UTC)
Subject: (no subject)
Except that arcane rules on when and how to pay earn profits for insurers and providers alike. Part of fixing our health care system will involve radically revamping our ridiculous administrative needs.
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dionysus1999
User: dionysus1999
Date: 2011-05-12 14:48 (UTC)
Subject: (no subject)
I find this rather odd, since I work at a major teaching hospital. Blue Care Network is the HMO of choice here, they have no problems with a resident. I suspect someone's doing the billing wrong, I believe the residents here are billed under the supervising doctor.

It might be worth your time to ask for a billing supervisor to review this for you. If you push, you should, if nothing else, get a discount for having to pay out of pocket. I also understand at some point you may want to throw your hands up and just pay the "damned" bill.

Insurance companies certainly do put up as many barriers as possible so they don't have to pay the bill. I can tell you from personal experience that the customer reps are just as incompetent on my side. And even after years of working with them they can still manage to "baffle me with B.S".
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Kari Sperring
User: la_marquise_de_
Date: 2011-05-12 18:48 (UTC)
Subject: (no subject)
WTF? That's insane.
There's only one solution. Move to the UK.
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Steve
User: anton_p_nym
Date: 2011-05-12 19:13 (UTC)
Subject: (no subject)
Well, to any other First World country really. Canada's single-payer system works more efficiently, too.

-- Steve may grumble about it's imperfections from time to time, but wouldn't want to see it disappear. (Heck, even the Canadian political right doesn't want it abolished.)
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Danny Adams
User: madwriter
Date: 2011-05-13 01:20 (UTC)
Subject: (no subject)
(And he's almost in spittin' distance of Canada.)
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