OK. Well, I fully realize that there are WAY bigger nightmares out there. But even for something as minute as a $185 claim, I have spent HOURS upon hours of time and energy trying to navigate my coverage with United Health Care.
We had a plan last year that provided NO coverage for "out of network" providers. It's a factor you work around. I did. I jumped through that hoop and drove double the distance to the "in network" provider. I found the provider to be - hm - bush league, sub-par, lackluster? But what i needed was a compression glove for my hand. What is required to order the appropriate glove? Well, they come in sizes and degrees of compression. By measuring the width of my palm and length of my fingers I determined the size I needed. And my PT advised me to get the lowest compression. There. That was easy. But, at the provider I had to get measured and they had to order it and through them, the glove cost was $231.85. I was covered for 80% making my contribution $47. OK. Seems pretty straight-forward. But this is the health insurance industry. They exist in their own universe.
I wait until I get a confirmation from UHC and have UHC call the provider to confirm my coverage before they order the glove. Now, it took many weeks and I ended up researching gloves online. I was able to purchase a glove for $90. Same product, different manufacturer. $90. It seemed to me, that perhaps, UHC would rather pay 80% of $90 than $231. But, They are after-all, the "experts". I'm just little old me.
Now it's 6 -8 weeks since I received the glove. I have worn it quite a bit, I've washed it. The thing is mine and cannot be returned. And so that is when I receive a bill for $185 to pay the balance because UHC denied payment to their in-network provider. Really. I'm not making this up. And I am not paying another $185 for this glove that I could have gotten from an online outlet without driving all-over-creation to comply with the network constraints for HALF that amount.
Again - this is piddly compared to people who might need chemo. My chemo, the very first treatment, got me to my out-of-pocket maximum for the year. It was THOUSANDS of dollars for each of the 8 doses. If I had had UHC at the time, I suspect that it may have been more of a fight to get coverage. Would I have had to wait weeks to coordinate the coverage and then, get billed for the denied claim after treatment began? As much as we know that we all would pay anything to survive - reality is a cruel fact sometimes. It would have been impossible for us to pay $4k every 2 weeks. Well, unless we moved into cardboard boxes under the overpass. So, $185 to fight about, in a sick-and-twisted sort of medical-insurance way is practically a blessing.
Now, I have no intention of paying that. So I called today and I spoke to the provider who confirmed what I said, they had received approval and then payment was denied. OK. My next call was to UHC. This involves several minutes of automated phone prompts and then repeating all that information once a human being answers the phone. We get through the pleasantries of my account and id numbers and I state that my claim was denied. Well, there is no claim - oh wait, she finds it. OK, it is listed under a completely different name than the place I went to . This new name, does not appear on the letterhead or bill from the provider (the "in-network provider"). I mention this to illustrate that the system (if you'll call it such) is really based on the highest level of ineptitude or confusion attainable every step of the way. Every step of the way there is a hurdle to jump and usually, it's moving and changing as you approach.
The poor woman who answered my call, she put me on hold once we determined that the date of service was Nov. 4, 2008, a date with no connection to when I called either UHC or their provider to order the glove, she comes back and says that she feels it should have been paid. She of course cannot implement that and I need to speak to a "resolution specialist". BUT… they had a system wide crash so I'll need to call back in a few hours. They cannot make a note to call me back because of the system crash. I guess, it would be too much to hand write a note and enter it once the system came up. Or, send an email to the resolution specialist du-jour or any other approach. Whatever. You know I'll call back in a few hours.
What are we doing?? Why are we allowing this as a society? WHY! We are better than this. These people who answer the phone, they probably get paid next to nothing, and I heard anecdotally that UHC has a mandatory HSA for their own employees. With an HSA, once you use up the savings, that's it. So, one story was a UHC employee's daughter broke her wrist. It exhausted the HSA and the family now has no additional coverage for the year. It is January. That is inexcusable.
What I am dealing is INEXCUSABLE. And all I can think while I fight for the coverage that we PAY for, is that they are screwing ALL of us. You, too! They are taking advantage, they are driving up costs, they don't cover preventative measures appropriately. WHY DO WE TOLERATE THIS?
Look, it needs to be overhauled like many of our systems. It needs to be scrapped and set up properly. I'm not a fan of socialized medicine, it scares me because I don't believe that the federal government should be handling it. There is no question that it is a deeply flawed industry. I have spreadsheet documenting this process and it's appalling. You know what gets me, is that I have insurance for pregnancy - I have every intention of not being pregnant again. I have coverage for IVF, for chiropractic which I don't use, we pay for these things we don't want or need coverage for. Why do we have group policies anymore? Do you want to fund someone else's IVF with your premiums? When we had an individual plan, we took off maternity because it nearly doubled the expense. If you don't need that coverage, why are you paying for it? and not only paying for it, but NOT getting coverages that you NEED.
RISE UP. There are many many things that we the people need to reclaim. We need the smartest among us to help design improved systems for health care, for lending and banking, for education of our children. Pick your cause and get involved. There is much more to do than plan the Super-bowl party or wait for your tax rebates. We need to step up and drive this country back to greatness.
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