life as understood

by jeff carr, master of the arts, -------------------------------------------------------------------------- presumably from a couch


three stories about the health care system

courtesy of Jeff |

Maybe it should be story problems, like in math class. Sure, let's do that.

Story #1:
Thanks to the Affordable Health Care Act, an attractive young woman -- let's call her Tara* -- returns to her father's health insurance through Insurance Company A. She's married, but under 26, so it's cheaper that way. Then, despite a hearty birth control regimen, she becomes pregnant.

Certain health issues make hers a high-risk pregnancy, and she could legitimately give birth anytime from March to May. In late March, after one or two labor scares and hospital visits, her father receives word that his company is switching everyone over to Insurance Company B, effective April 1 -- almost immediately.

Tara is in no position to switch doctors or providers at this point, especially since she has been receiving special high-risk care, and she knows the baby could come anytime before or after April 1. And besides, pregnancy is a clear pre-existing condition that she is assured will be covered by the new plan. Tara is issued a brand new Insurance B card on April Fools' Day. Four days later, she gives birth at Hospital AB, the only option afforded by her provider.

Thankfully, mother and baby are reasonably healthy, despite negligence on the part of Hospital AB that requires the baby to be re-admitted and placed in the NICU at Hospital K less than 48 hours after discharge.

Months later, Tara learns that her father's company, under the new Insurance B plan, will not in fact cover the birth, since the baby is the dependant of a dependant. She would have been covered under the Insurance A plan, and Insurance Company B itself even said they would cover it, but according to dad's company, as of April 1, "we don't do that anymore." The baby has been on Tara's husband's insurance (Insurance Company K) since birth, but Company K covers very little at Hospital AB, where Tara was forced to deliver.

Tara and her husband do not have the means to pay for the birth, and they're not sure how this all happened.

Question: what could Tara have legitimately done differently? What can she do now?

Story #2:
A man calls Hospital K and finds out he has an outstanding balance of several thousand dollars. The billing agent asks, "Would you like to take care of that now?" The man expresses surprise at the amount, as it seems well in excess of his out-of-pocket maximum.

"But this says you were uninsured," the agent says.

"No, in fact, we're insured with you -- with Insurance Company K."

"Oh," says the agent. With almost no effort, he pulls up the correct account.

Some time later, the man receives a much smaller bill, which he pays immediately. He is never issued an itemized statement, however, despite his having asked upward of four times for such a document over the course of two months. If the receipt is not received and faxed to the debit card provider soon as proof of an eligible medical expense, the payment will be rendered null, the card will be disabled, and the bill will likely be sent to collections.

Question: Is this also an indication of our broken system, or is it simply that the people who process billing at health care providers are broken? How many people end up paying more than they should?

Story #3:
A man -- Josh, perhaps -- and his wife receive a call from a collections agency regarding thousands of dollars in unpaid medical bills at Health Provider AB from more than a year before. They're confused. This is the first they've heard of any such charges, and in fact, they don't even make sense. Josh's wife is listed as the patient, but she received no medical care during the specified time period.

Josh makes a call to the collections agent, who is just as confused as he. She can't figure out what the charges are or why they weren't covered by their insurance. Josh makes several calls to Provider AB, and is given different answers each time. None of them seem to believe Josh's story -- that his wife never received any such care. On the third or fourth call, a Provider AB billing agent tells yet another story, that the charges are not, in fact, for Josh's wife, but for his son. The agent says the charges are so high because Josh's son was uninsured.

Josh knows that his son was on the state's Medicaid program at the time, and that Provider AB had billed it correctly on several other occasions. But at the time of these phone calls, Josh no longer has his son's Medicaid card, as that account has been inactive for almost a year. Josh spends hours and days on hold with the state's Medicaid program, which actually usually ends up with him being transferred to phone numbers that don't work, and therefore simply hang up on him. When he is able to speak to a human, the human often tells him that Medicaid numbers can not be released over the phone. He orders a Medicaid verification letter to be delivered to his house. A month passes, and it never comes. He spends more hours and days on hold, and then once, for no apparent reason, a human is more than happy to give him his son's Medicaid number.

Josh gives the number to Provider AB, who says they'll work on reversing the bogus charges. The outcome remains to be seen.

Question: WTF?

Responses will be accepted in the comments section, though aggressively partisan arguments risk deletion. These problems (especially as expressed in Story #1) are at once nobody's and everybody's fault. I'm not sure if dealing with them feels more like the eastern hemisphere, the past, or fiction. It could be Dickens's Circumlocution Office, which I guess is technically all three. Anyway, for the first time ever, I think I've actually lost all faith in an American institution, and that makes me sad.

*The names have been changed so as to not make it sound like I'm just whining, though I suppose I am. I'm honestly just more blown away by the failure of the system than anything. If you hadn't figured it out (Josh and Tara -- come on), each of these stories is about us. This may be the first time that sheer exasperation has driven me to blogging, which goes to show just how out of ideas I am.