Wednesday, January 14, 2009

Not all the health care screw-ups can be blamed on the insurance companies...

... at least not while there are doctor's office like this out there.

OK, this takes a little detail, but bear with me.

My daughter finally landed a full-time job with benefits. After the 90-day waiting period, she qualified for health insurance and was more than ready to ditch Medicaid.

As the world turns, she needed the coverage even before she got my grandson to the pediatrician.

On January 5, 2009, at about 645pm, my thirteen-year-old son and my five-year-old grandson were horsing around in the basement (which is where we send them to beat on each other) and the little one jumped off an eighteen-inch-high pillow, landed on a thick carpet ... and broke his leg.

So he went to the ER, got x-rayed and set up to see an orthopede for a cast 48 hours later. This, of course, now required a call to the pediatrician's office to get a referral.

Even though that office had received both the cancellation of the Medicaid and the new insurance number, they promptly called the hospital and told the orthopede's office that the kid didn't have any insurance. Fortunately, the hospital called us back, and then we called the pediatrician's office to say, What's your problem? Oops, they said, we do have that number, don't we?

So that gets straightened out, right. Yeah, sure it does.

The next week the little guy had to go see the pediatrician for a rash that had developed around the cast.

They usher us right into the examining room without ever doing the has your insurance changed, give me your card, and where's the goddamn co-payment routine, which I found peculiar.

When we were through, I asked the doc if we needed to check out. No, she said, you're done.

Except that this new insurance has a $25 co-pay....

So I said (like an idiot): What about the co-pay under her new insurance?

What new insurance? She's a Medicaid patient, they tell me.

No, I said, she's not any more. Don't you remember that whole bit last week?

Oh. Yeah. Here it is. Right. Can we copy the card?

Me: actually, i don't have it. My daughter's at work in Pennsylvania, but I can bring it by tomorrow or the next day.


What about the co-pay?

We'll just get it then.

The next morning the doctor's billing department calls my wife to threaten that she was going to bill us for the whol cost of the appointment if we didn't get that card to her like twenty minutes ago. My wife, recovering from back surgery, still can't drive; my daughter and I are both at work until after the office closes. She explains this. She explains that they've got the account number and that they refused to take the co-pay yesterday. The woman reiterates her threats.

The next morning, minutes after the office opens, I show up with THE CARD. They take it and photocopy it, but still don't collect the co-pay. Why not? "We only take that at the time of service, or we bill you for it." The woman telling me this is standing beside a sign that reads (essentially): If you don't pay your co-pay at time of service we will add a $15 fee if we have to bill you.

I say... Well, you can probably fill in the blanks here.

She says, Well, if you couldn't pay the co-pay yesterday, then we'll have to bill you. And if you don't pay the late fee, we won't see your grandson again unless it's an emergency.


(Channeling my inner donviti...)

Sir, you didn't have your card yesterday, so we had no way of knowing what your co-pay was. Therefore we couldn't take it.

But I told you what it was, and this is a standard Blue Cross policy that your office accepts for dozens of patients every day--of course you know what the co-pay is... and I told you what it was.

Sir, we have a policy, that if you don't present the card, we can't take the co-pay....

This eventually deteriorated even further but you are hopefully get the idea...

I have to be completely honest: I have spent two decades working with and through the worst that the health insurance industry could throw at anybody (I've gotten over a dozen surgeries authorized; hell, I've won appeals that extended hospital stays for as much as a week), and I have never--NEVER---had to deal with such amazing incompetence as this office.

I'd love to draw some neat libertarian conclusion about all this--but tonight I'm just pinging back and forth between bemused and pissed.

And--by the way--I have absolutely no intention of paying the $15.


Brian Miller said...

High regulatory barriers plus overcertification (both supported by the AMA) leads to both a chronic shortage of physicians and specialists, as well as a oligopoly over care.

In a true free market, this doctor's office would not be long for this world with service like that. But since our lovely regulated medical system mandates what insurance you can have and restricts the supply of medical professionals (also driving up salaries, which the AMA *loves*), we get to "enjoy" this sort of service regularly.

Now make the nightmare even darker -- imagine a single-payer government monopoly over health care, where there's even LESS choice... and where the surly clerk works for the government.

Replace the existing equipment with 25-year-old equipment, add a very long waiting period, and an English accent, and you've got the UK's NHS service (which almost managed to kill me during a particularly bad bout of food poisoning when I lived in England years ago).

Anonymous said...

I surely don't want my trip to the doctor to be like a trip to the DMV.

Anonymous said...

I have had nothing but contempt for the billing Nazi at my Dr's office. I wonder if the reason she is there is because she is really good at the whole insurance/billing thing and has no people skills.

If that were true, perhaps the Dr's wouldn't need to hire these evil billing people, since the process could be standardized in a single payer system.

Once I get to my doctor, he is great, but today I have to wait for long periods of time before seeing him for a non-life threatening issue. Why is our system so great again?

tom said...

It's worse. Obama has made a health-care package one of his top priorities according to If you believe DownSizeDC, they plan to introduce it very soon.

Brian Miller said...

the process could be standardized in a single payer system

Yes. It would be "great, you need chemotherapy. Looks like our next slot is open in.... 600 days or so."

But I need chemo within a couple weeks or I'll die!

"Well, sir, let me see if I can find another slot for you. Are you willing to travel?"

Yes, I'll go anywhere.

"Oh, great. Looks here like we can get you in a hospital in Nome, Alaska in just 290 days."

But I will be dead by then!

"I'm so sorry, sir, but there's nothing I can do."

The Mudslinger said...

I'm glad I've got Lumenos and avoid that whole mess...

Anonymous said...

I work this gig. Two issues here. You should have had the kid return to the orthopod for treatment, and then there would be no co-pay, because the injury falls under complete care for so many weeks.

Then if the BC/BS is not in effect yet, the Medicaid is, and should be billed accordingly.

Please don't go to the mat over 15 bucks. Think how much was provided prior to this thru Medicaid, and no charge. Make someone's day, pay the fee whether the were rude, wrong, or ill-informed. It will save you much grief in the end. And me as a taxpayer, doesn't feel stiffed that a public provided service, ran into some hassle on the switchover to private insurance, to allow any leeway/recheck in setting up the collection. Remember, Medicaid was there for them, no hassle, on the public dime. Can't you at least pay it forward to extend mercy in another end of the deal?

Steven H. Newton said...

Your level of condescension is only matched by your inability to read the post correctly and your ability to draw incorrect inferences when information is missing.

I've been dealing with all kinds of health insurance for decades; both in and outside the medical establishment.

The orthoped was called and referred us back to the primary care (your first incorrect assumption).

The BCBS was in force and the Medicaid had been appropriately ended AND the office had already had several weeks notice. The same office that acknowledged to the orthoped that there was no Medicaid but "forgot" to tell him there was new insurance. (you missed that one)

I gave them the proper information at every step of the process; I offered repeatedly to pay the correct co-pay. Their response? Not rudeness, but threats.

And so you think I should pay the extra $15 to encourage them to treat other patients in such slipshod manner?

As for your little diatribe on the social value of Medicaid--give me a f**king break. Medicaid repeatedly refused to pay legitimate claims, submitted through the appropriate procedures by multiple doctors, sometimes for months.

Medicaid illegally (by the opinion of the Attorney General of Delaware) attempted to cancel the coverage not once but four times in the past two years.

Medicaid routinely refuses to pay for prescribed, documented anti-depressant medications.

Without cost? As a taxpayer you are being hustled if you think this program actually works.

But I'll keep your comments around as a reminder that poor behavior on the part of supposed professionals should not only be tolerated but rewarded.