Category: healthcare

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One of the continuing irritations with the present medical system is the administrative confusion that arises when it is time to pay the bill. For some reason, the provider and the insurance company make me the middle man in their struggle for payment or for non-payment as it were. Now the only value, to use corporate speak, that I bring to the argument is I don’t want to pay the bill.

Nonetheless I am continually being dragged into these discussions where my growing irritation is the only clear relevance I am bringing to the debate.

My participation usually begins when the provider, after numerous attempts, has failed to get payment from the insurance companies. They then decide to bill the patient which seems fair and reasonable as the patient ultimately received the service.

Let’s stop here for just a moment. I thought that this was a service that was paid for by my insurance company. I never expected to be billed more than the co-pay. All I can add to the discussion is I didn’t expect to be billed. The provider, rather cleverly, has pulled me into the argument.

But why? I don’t know the arrangement between the provider and the insurance companies. I don’t know how the provider is supposed to code their bills in order to get payment. All I can do is complain to the provider for billing me which is where the provider explains their dilemma — the insurance company won’t pay.

Apparently the ire of the patient helps the insurance company to do the right thing. I grudgingly can accept this tactic although I am baffled why the provider can’t just work it out with the insurance company without involving me. I suspect it is based in confrontation avoidance of the young office workers tasked with resolving these matters. For some reason, they would rather piss off me over pissing off the insurance companies.

Any way, this is where things get truly irritating. The provider wants me to contact the insurance company in order to get payment. WTF. Why am I the one calling the insurance company? Why can’t the provider call them? I am embarrassed to say I fell for this little gambit numerous times mostly because I fear having to pay a large dollar amount bill.

So, I would call the insurance company who then tries to explain to me what the provider needs to do in order to get payment. I am not the one who needs this information. I am not billing them. I don’t care what the provider needs to do, the provider does. At this point I suggest that the insurance company calls the provider to explain. This is usually greeted with mumbles and vague promises to contact the provider. Speaking from personal experience this rarely happens.

Because the insurance company has provided me with some useful information that might help the provider get their money, I try to pass that on to the provider the best I can with the suggestion that they themselves might themselves call the insurance company to ensure I have my information straight. More mumbles and more promises. Speaking from personal experience this rarely happens. I know I repeat myself.

The good news is I have came up with a new strategy that sometimes works. I don’t pay the bill and you know the provider and the insurance company seem to find a resolution without involving me. It sometimes takes awhile but they eventually work it out without me paying a thing or becoming the middle man.

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I have spent the last few days in the bowels of the American Medical system as Bob, my partner, took a fall and has been experiencing the noxious gases of this infernal system.

The profit motive is a terrible way to make decisions about a person’s health. What may be the cheapest way to handle a problem may not be the best. Bob took a fall and damaged both legs. He can’t put pressure on either leg for now. This means that the simplest task is virtually impossible for him to perform. We are out of town in Modesto and need to get home for his surgery because the recovery could take up to three months. It makes sense to send him back to San Diego where we live.

The solution they are purposing, however, is ridiculous. They want me to pack the very injured Bob into our car and drive for 7 and a half hours to San Diego. Right now, he can’t get into a wheelchair without the help of two medical professionals. Yet they want me, a 68 year old man alone with a 76 year old physically incapacitated man, to make this car trip.

Now this is where things get interesting. When we balked at this suggestion, the case manager at the hospital decided to argue that it was cheaper for a medical vehicle to take him back San Diego than for Bob to stay in the hospital until he is physically able to make the trip. Brilliant right.

Brilliant and horrifying. The thing that is deciding how to proceed is the cost to the insurance company (in this case Medicare) and not the health of the patient. Even more horrifying is that the people who look at spreadsheets could decide that it still makes more economic sense for me to drive him home.

Now I get it, money has to be taken into consideration at some point but it seems like this is not one of them. The bean counters are weighing the economic cost of two options — paying for an ambulance or paying for a hospital stay. The deciding factor isn’t the health of the injured man. And, more importantly, why do the bean counters seemingly have the final decision. And don’t say the doctor has the final say. The case worker’s argument is financial because he knows the bean counter has the deciding vote. If Bob’s health mattered, the argument would be it is better for his health to be driven home in a car with medical professionals. Right?

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I recently wrote about the murder of Brian Thompson, UnitedHealthcare CEO. People who I respect were arguing that the people really don’t have much power over healthcare executives and that, given the political climate, weren’t likely to see any changes. This forced Luigi Mangione into action. His frustration with the system gave him no other choice. I wanted to respond to these arguments but I couldn’t quite get my ideas straight about what I wanted to say. The massacre in New Orleans have clarified things for me.

The killer in New Orleans’s probably felt similar to Luigi Mangione, that nobody was listening to what he had to say and, in order to change that, he took extreme action to bring attention to his cause. Since US government is part of the problem, then all Americans are legitimate targets until the US government changes their policy.

Now I don’t believe that to be true and I am betting the most other Americans agree with me. The problem then becomes why is it all right to kill Thompson and not the party goers on Bourbon Street. It becomes a matter of splitting hairs. Thompson definitely held more power over his company than the average American has over government decisions. A terrorist, however, might argue Americans have the power to vote for their leaders. If they are going to vote for the leaders who oppose their cause, then they deserve to die until Americans change to a more ISIS friendly government.

If frustration with the system is a legitimate reason to massacre people then who is to say your frustration is better than my frustration. It is wrong to stay silent when the people dying are disagreeable people. Disagreeable people deserve due process and fair trials because we, as a people, have to know that we there is justice in the process and we are not just going after people we don’t like. Letting lone assassins make that decision is insanity because you are then are opening up political violence option to everyone, including people you disagree with, and who then will kill people you like.

The election of Trump was an incredibly disappointing result but then there is another election coming and, depending on how things go, the political climate could change. At least, this is the way forward I would like to pursue. Call me bourgeois but I much prefer the chaotic and slow machinery of democratic institutions than political violence. I can’t give up on it just yet. It worries me that so many people seem willing to let murder slide as long as the victim is perceived as a legitimate target because someone might decide that you are a legitimate target. Just ask the families who lost a loved one on Bourbon Street.

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I received a bill the other day for $1,400 for a procedure performed on me in February. It was so long ago that I didn’t even remember having a procedure done in February or why. I went through my Insurance submission statements to refresh my memory. I couldn’t find anything that quite matched either the date the provider gave or the price they charged.

So I called United Healthcare’s (UHC) customer service. The agent also was unable to explain what was going on so she put me on hold as she needed to talk to a supervisor. One half hour later, she has an explanation. The provider didn’t submit their bill in a timely manner so UHC declined payment.

This was, in no way, a satisfactory explanation because the company was now billing me instead of the insurance company. She then helpfully suggested calling the provider and asking for them to resubmit. This made no sense to me. First, UHC declined payment because the provider had exceeded their deadline for submissions. Does resubmitting the bill put it through some time machine which then makes the bill be on time? Furthermore, why does the provider now think I am responsible for the bill? I didn’t submit the late bill and I didn’t decline payment of the bill. This, as far as I could see, had nothing to do with me at all. It was between UHC and the company billing them.

The agent was speechless for a few seconds as she didn’t have a canned reply for my question. These questions stunned her into silence. Finally, she managed to repeat her previous statement about asking the provider to resubmit. I explained to her that she could call the provider and tell them to resubmit herself as this had nothing to do with me. She was so silent that I had to interrupt her silence with a question, so if UHC declines payment again then UHC will tell the provider to stop billing me because they screwed up. More silence.

I tried a different approach. “So, I shouldn’t pay this bill because all the provider has to do is resubmit the bill and they will get paid.” More silence. Finally, the poor thing lamely offered that I should call the provider and ask them to resubmit their bill. I asked again, “And then they will get paid, right?” Silence. I asked, “what if UHC denies the payment again and the provider bills me again what should I do.” Again silence.

I asked to speak to a supervisor but before I was disconnected from her I asked her to make a note in my file that I am not paying this bill until I get an explanation. I did this because I rarely, if ever, get connected to a supervisor. I didn’t. Odd that because she had just spoken with one regarding my claim but then I image UHC supervisors are bombarded with agents asking questions. I was forced to leave a message. My experience with leaving a message with my insurance companies or any medical provider regarding a billing question is that I will never receive a call back and I haven’t. It now has been over 48 hours which is the time frame UHC gives for these return calls.

So to sum it up:

1.UHC declined to pay for my procedure because the provider failed to bill them in a timely fashion.

2. Because the provider didn’t get paid in a timely manner, they are now billing me.

3. UHC won’t do anything to help me. They expect me to contact the provider in order to resubmit their claim and won’t guarantee that this resubmission will result in payment.

4. Which is kind of shitty behavior because the provider did supply the service and they do have a contract with UHC. But OK, I get it, there has to be some deadlines for bill submission.

5. It is equally shitty that UHC expects me to do their legwork when I have nothing to do with the problem. They declined payment based upon guidelines that I assume their providers are aware of. It then becomes their responsibility to inform the provider to stop billing me as they didn’t follow UHC requirements for billing.

This took about 45 minutes of my time to have, at the end of this call, absolutely no resolution to my problem. I am certain that I have another long phone call with someone in the future. This is horrible customer service and very suspicious too. Why are they asking the provider to resubmit? If there are rules regarding submission, there are rules. If the provider didn’t follow these rules, then the provider doesn’t receive payment. It sounds like they are trying to get the provider to back down or for me to pay the bill. Does this mean if they get harassed enough by the provider and the customer that they will grudgingly pay.?

What did Luigi Mangione’s put on his bullets: Delay, deny and depose.

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United Healthcare is a good place to start when looking at the problems plaguing our healthcare system. Two things stand out $24 billion dollars in profit and the highest denial (33%) of service rate in the business. Profits are a part of the American healthcare system but it would seem that $24 billion is a bit unseemly particularly when many Americans find it difficult to purchase healthcare insurance due to cost. The company could surely get less in profits so that more people are insured. Oddly enough, it might even bring more revenue into UHC as the more people insured by UHC, the more money coming into their coffers. .They could cut their profits by just a billion to test it out with little harm done to anyone.

Then there are the denial of service rates. If people loved Healthcare insurance companies and thought they were doing their job fairly then I could actually live with $24 billions in profit. But they aren’t. People are so mad that security experts couldn’t understand why Thompson failed to have a security detail. He was a sitting duck for any assassin.

Let’s think about that for a moment. A CEO of a large insurance company is putting his life at risk simply by walking the streets of New York. If people want to kill you because your company’s treatment of its customers is so bad that a few are willing to throw their own life away to kill you should be a wake up call. At the very least, your company has failed to do a good job explaining its processes and procedures to its customers and, at the worst, you have been caught bilking your customers for money. A good portion think the company is screwing with them to save money. How else do you explain $24 billion in profits and industry high denial of service rate? I haven’t heard a good explanation yet.

Here is the saddest fact of all — the awful reaction to Thompson’s murder. A lot of people are OK with it. If nothing else shocks the insurance industry, this should. Your reputation is in such disrepair that people can live with insurance executives getting murdered because these same executives don’t seem to be reacting to the genuine need for people to have their healthcare paid for at a reasonable rate. They are tired of the large expense and they are tired of fighting with insurance companies over unpaid bills. What are they going to do about it?

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I have been trying to write about the murder of Brian Thompson but I am having difficulty finding the right words. A lot of people I know and respect are, at best, indifferent to his murder. I agree with their issues about healthcare in USA and I agree that it is a mess. But this is about cold blooded murder. Just because you have a good motive, doesn’t mean you should do it.

Here are my reasons:

  1. I am against murder. Nobody has the right to take another person’s life no matter the crime.
  2. I am for trial by jury. If somebody is guilty of a crime there needs to be a trial. This didn’t happen. One man took it upon himself to execute another human being based on his opinion and his opinion alone. There was no chance for the CEO executive to make his case.
  3. I am against capital punishment. Even if he was guilty of murder, I don’t believe it is right for anyone to be executed for their crimes even if that crime is murder.

Some of the reasons I hear for the indifference is that it will put Healthcare executives on alert. Change your ways or someone might kill you. This is a horrible state of affairs. How is making someone afraid an argument for anything? It is coercion plain and simple. More importantly, they might just opt for better security over changing their behavior. They after all have billions in the bank.

But, this is the first shot for regular people to take back a system that no longer works for them. Well, maybe but then again maybe not. Trump just won election to the presidency. Something that many on the left couldn’t even image happening, but it did. It is incredibly wishful thinking that people might rally around Luigi Mangione and take to the streets in order to overthrow the healthcare oligarchs. A jury might as easily prefer stringing him up instead of celebrating the killing of a capitalist pig.

Which brings me to January 6. If the people who broke into Congress were wrong, and I think they were wrong, then so is a person who murders a man in the street. Violence against persons, no matter how rotten they are, is intolerable.

But the system is broken and the people have no avenue for justice. Again, isn’t that what the January 6 rioters are saying as well? If the system is so broken that both sides are willing to use violence as a method to gain their point then when does the violence stop. When my side gets its way? And, more importantly, will the other side stop using violence based on this defeat. That doesn’t seem likely, at least not without a lot of bloodshed. I, personally, would like to avoid that.

Thinking that revolution is around the corner is a chimera. Look I prefer a single payer system but, given the American public’s attitude towards capitalism, it seems unlikely for the foreseeable future. This means we settle for the best deal we can get which is far less exciting but more likely to happen. I would like to think we have not given up on compromise just yet and that a deal can be worked out. I certainly don’t want to see bloodshed in the streets of our cities.