Tag: healthcare

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Since Bob’s fall, I have learned the secret of getting what you want in the American Medical System — be aggressive. It is the one piece of advice I get from almost anyone who has had any dealings with the system. Be aggressive. You have to be an advocate for your loved one in order to get the treatment they deserve. This advice is given to me so often that it took me awhile to hear what people are actually saying.

I thought good medical insurance was sufficient for good treatment but it also helps to be a bit of an asshole. Now some of you will say being aggressive is not necessarily being an asshole. You can politely but firmly be aggressive. But that wasn’t the advice I was getting. People were actually saying be an asshole, get in their faces, don’t let them push you around. Some of this advice came from medical professionals.

Also, and this is important, why do I have to be aggressive at all? If my insurance covers it, why do I have to aggressively monitor his treatment at all. He should be getting it without asking. But this isn’t the impression of an awful lot of users of the American Medical system.

The saddest part of this advice is we passively accept it as they way things are. The only way to get good treatment is to be aggressive. So, yeah, mother fucker, I will do whatever it takes to get my loved one what he needs. My biggest worry since Bob’s accident is am I being aggressive enough. What did I fail to see or do. Who should I be chasing down. Will Bob get screwed by some mistake I made. This is hardly conducive to healing the patient and it is exhausting for his loved ones.

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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 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.

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I wait to pay medical bills because the first billing is almost always wrong. The medical office is waiting for an insurance payment, or a deduction based on some deal that the medical office has made with the insurance company which reduces my bill hasn’t been received, or, and this happens to me a regular basis, the bill is just wrong and the medical office will sort it out on about the third time it bills me. After all this to and fro with payments, I then jump in fairly confident that I am now dealing with the amount I owe.

Back in May, I started the process with one such bill and found that I owed $35. I could account for $15 but I couldn’t account for the other $20. I examined my bill and found the missing $20 but it was showing as a payment and not a debit. I called the office and explained my situation to a Customer Service representative. She went through the bill and saw the problem and instantly was confused. “It is in the wrong column.” My concern was what if it is in the right column but wasn’t deducted as it should have been and could she ascertain whether itr was a credit or a debit. She puts me on hold in order to talk to a supervisor. After about ten minutes she returns, she and her supervisor were unable to determine whether the $20 was a payment or a charge and she would need to investigate. She assured me that she would call me back. She did not.

So in June, I received another bill for $35. I again call Customer Service. This time I was unable to reach a representative. There were too many calls in the queue and my wait time would be something like a half of an hour. I was instructed to leave my phone number and a brief explanation of my problem and that I would get a return call within 48 hours. I never received a response.

In July, I received another bill for $35. I again called Customer Service. I again was unable to reach a representative and was told there would be a long wait before I could talk to one. I again left a message but added the number of futile attempts I had made to resolve this matter and how I would really appreciate a return phone call. No one called me.

I didn’t receive any bill in July, August or September. Thinking that the matter had been resolved, I waited to receive the bill for the correct amount – $15, instead, in October, I received a check for $35 with no explanation of how they determined they owed me this amount.

I am certain that I owed them $15 but now, at least I think this is true, I owe them nothing and they gave me $35 to boot. I can’t wait to see my next bill.