Log in

No account? Create an account
[cancer] Best healthcare system in the world, my tumor-riddled ass - Lakeshore
An author of no particular popularity

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.

Post A Comment | 21 Comments | | Link

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.
Reply | Parent | Thread | Link

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.
Reply | Parent | Thread | Link

my journal
January 2014
2012 appearances