1.28.2008

HBB: Insurance and doctors

There are times when I’m reminded that the medical world is a business. As all businesses, making money is important. There is nothing necessarily wrong with this. If practicing medicine didn’t provide money for doctors, hospitals, labs and research facilities, then who would get into the business? I know there is the argument of state-run medical care, I won’t touch that debate. And, I also don’t want to discredit that EXTREMELY caring nurses, technicians and doctors I have met in the medical community. But, if the facility these caring people worked for didn’t make money, these people wouldn’t have a place to provide their care.

But, I have found that I can get lured into a kind of comfort that the medical community is out for my wellbeing. They are. Just so long as they make money at it.

Of course, the same goes for health insurance. Only double.

As much as we might complain, what’s the choice? I don’t see another immediately available choice but to work with these two groups – the medical providers and the insurance companies.

Today, I was reminded of the money aspect of healthcare. I have the fantastic fortune of going to a good, very respected medical clinic near my home. Because this clinic is so well respected it even draws people from around the country. Unfortunately, this makes this clinic expensive. To be exact, most procedures at this place are around three times what the insurance company is willing to pay. NO, this isn’t some wildly exaggerated amount. Really, 3 times the “usual and customary” that my insurance will cover 80% of. So, doing my math, that means insurance covers about 27%. I talked to this clinic about their high cost. And, I kid you not, the business office person replied “well, we are three times BETTER than everyone else”. That could well be. I’ve checked that out and it likely is true.

I withheld some payments to this clinic to get their attention so they would help me work with the insurance. The woman in the business office agreed that I had not withheld these payments, I probably wouldn’t have gotten their immediate help to work with insurance. It was to no avail. The insurance company did not back down. The only change was that I had to go into a little room before every appointment and pay for the procedures before they were done. It was humiliating.

Finally, I tired of the expense and abuse and I contacted the insurance company. I asked who they would have me see in place of this renowned place. I went to the doctor they suggested. I have to breathe deeply before I start a spew of strong words against this medical experience. This doctor’s arrogance and incompetence wrecked a price on me that was phenomenal. My brother, a surgeon, heard my experience with this doctor. He suggested “quack” was too kind.

So, I decided to do whatever necessary to return to the good, expensive, effective place. I did. With a little work I have it up to insurance covering half the expense. On some seemingly random occasions, insurance has covered all the billing from this place.
So, this is the background to today’s story. Today, I got a call from the business office from this cutting-edge clinic. They told me that they had just gotten off the phone with my insurance company and my insurance company told them that I was losing my health insurance in two days.

Maybe your healthcare costs aren’t similar to mine. So, maybe this wouldn’t stop your heart quite the same as it stopped mine. I was shaking. I could hardly dial the phone to call the insurance company. I got a very nice, very helpful woman. She told me that sure enough the screen showed my insurance expired in two days. She asked if I had paid last month’s bill. I was already on the computer finding my cleared check online. Yep. Paid. Nothing else had changed.

Did I have a heartbeat? I don’t think so. She said she would go check something and she put me on hold.

She came back on and explained that the expiration date didn’t mean the same thing in my type of insurance and all was well and I would continue to be covered.

My heart started. I had no idea if I should be angry or grateful or relieved or annoyed or…. Had I not been at work, I likely would have let out some kind of yell – joyous or angry or otherwise.

I must say, both the person at the clinic and the person at the insurance company were very professional and helpful and kind.

Somewhere along the line, someone made a mistake. Mistakes happen. I’ve probably made a dozen in the last half hour.

I know I am amazingly lucky. I have absolutely nothing to complain about. I DO have insurance. I DO go to very good clinics. I AM doing better than anticipated. I do understand how many there are who are not so lucky.

But, it was still a scary view into how much I rely on this whole infrastructure of insurance and medical community, and these two getting along, and that all will work reasonably well where these are intertwined.

As of today, it appears there isn’t any unraveling going on for us. I think I’ll go eat some carrot sticks to celebrate. I guess the best way to avoid these hassles is to avoid the need for doctors. That's what I'm told, anyway.

6 comments:

KinnicChick said...

You know what my reaction was when I read this yesterday. And I've gotta admit, my heart is still a little racy at the thought of it as I glance through it again. Oy. What a scare. Jeebus.

HalfBrainBoy said...

Yeah. Scary. It's one of those things where I didn't realize how scary until I thought it was happening. We are talking a COMPLETELY life-altering event if we lost health insurance. *Shivers*

Heather said...

I'm so behind in my reading but the entire insurance industry is awful. It's amazing you were able to contact two people that cared enough to help. I haven't had insurance in 3 years because we make too much for the state funded insurance and too little to pay out of pocket. I don't expect any handouts but they need to do something better than what they have for those self employed. We ALL need health insurance.

MysticalMarge said...

I'm with Heather. Health insurance sucks. For my high(est-available) deductible plan for coverage plus a modest $100/mo to my HSA I have to pay over 20% of my net income. And I HAVEN'T needed to see a medical doctor in several years and I don't take any prescription drugs. There's GOT to be a better way! Penalizing people (as proposed by some politician or another)who don't have health insurance isn't it!

michelle de seattle said...

I'm thinking of going without insurance since I can't deduct my COBRA payments but I CAN deduct my medical bills.

I'm sorry about your horrible hour and hope your heart rates are back to normal.

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