Tag: Health Insurance

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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 was appalled to read that Mary Lou Retton, Olympic Gold Medal winner, doesn’t have health insurance and has to raise money for her hospital stay through an on-line fund raiser. She has a life-threatening pneumonia and is in critical condition. She has been in the hospital for over a week, so you can imagine the cost already and she isn’t out of the woods.

How does someone so well connected not have health insurance? This absolutely blew me away. If Retton is taking risks regarding health insurance, then the number of people who faces these choices must be much larger than I imagined. This doesn’t mean that they decide not to get health insurance either, they may decide for health insurance but what are they doing without. This is about life on the margins where the cost of health insurance might make people sacrifice other necessities of life — like not paying the mortgage, half dosing prescription medicine, skipping meals. But, then, there will be people who will argue that this is good, Retton will make better decisions in the future from the lessons she learned from not having health insurance.

Like delaying necessary treatment because she doesn’t have health insurance. I can’t imagine what I would do if I were sick and didn’t have health insurance. You don’t know if you will get off easy with $100 bill for a doctor’s visit and prescription or a $50,000 hospital stay. And even if you only have to pay $100, it may be $100 you don’t have, so what do you do? How is not taking care of your health beneficial to society?

Then when you are so sick you have to seek medical treatment, who pays the bills when the person involved is not America’s sweetheart? What happens to a person who is an asshole and people hate the person so much that they are angry at you for even thinking of helping the asshole. Though it pains me to say this — even assholes deserve healthcare and they probably won’t fare well in the Go Fund Me Route. So instead of contributing to every Go Fund Me asking for help with medical bills, our system is set up to treat everyone through a universal health care system.

That won’t happen because that is socialism and socialism is bad. I honestly don’t care how it is done either. If you can propose a way to do it through the markets and it is both affordable and universal, I am cool. But I haven’t heard one yet so there is that. The Republicans, who I would assume after bitching for 8 years about Obamacare, would have passed reform bills with these market solutions incorporated when they took over, but they didn’t so it looks very much like they don’t have anything. Which is unsurprising but nonetheless disappointing.

Until then I will continue to enjoy the best medical care in the world.

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A television ad blew my mind the other day. An American Health Insurance companies was offering health plans that included Mexican doctors. I thought this had to be wrong. American Insurance companies would never include cross border doctors. I was wrong. I googled it and sure enough I found a Health Insurance company that includes Mexican doctors. Forget the bullshit about being culturally sensitive and giving customers a wider network of doctors. They can’t contain themselves about the real reason. I am betting you already know the answer but just in case you are struggling, I will let you know — it is cheaper. The lower co-pays for using Mexican doctors gave the game away.

Living on the Mexican border, on and off, for the past 30 years, I knew people who have crossed the border for medical care but I always was a little suspicious because there alway seemed to be some horror story attached with the doctor’s visit to Mexico. Plastic surgery gone wrong, dental work that turns into health emergencies. Of course, the same horror stories happen with American doctors every day so why this influenced my thinking is a mystery. I am sure it has something to do with having been told my whole life that American healthcare may be expensive but it is the best in the world

But now that American Insurance companies allow Mexican doctors in their plans, this lays to rest these concerns. Of course, it also raises a big question – why is American healthcare so much more expensive. I mean, any insurance company that includes Mexican doctors has to believe that Mexican doctors are, at least, comparable to American doctors or why would they include them in their plan. They could never publicly say there is a difference in service because to do so would undermine the whole idea of American Healthcare which is price doesn’t matter. The quality is the same, the different prices customers pay only means lower co-pays, lower deductibles. and more doctors in the plan. But the quality is exactly the same.

How, then, can American Insurance companies continue to say that American Healthcare is the best service at the best price when they are also willing to pay for comparable services of Mexican doctors which is a lower rate. It is a contradiction that requires some explanation. I am listening.