Vent about health insurance and how screwed up it is

[disneysteve]

As you all know, I'm a physician. I dont' usually rant too much about our healthcare system but I thought I'd share a couple of recent stories that show how screwed up things are and how it really isn't the fault of the doctors even though they end up getting blamed much of the time.

1. We got a notice from an insurance company that they were taking back a payment they had made to us for an office visit we had done. Why? Their records indicate that the patient was actually incarcerated at the time of the visit. We saw the patient. We have documentation that we saw the patient. Basically we can prove that the patient was seen in our office on that day and was not incarcerated. Doesn't matter. The company isn't paying us. So we're out the cost of providing that care for no logical reason.

2. We saw a patient for an office visit last month. My biller submitted the claim to the insurance company only to get a rejection letter saying the patient wasn't signed up with us. In fact, the patient was signed up with us at the time of the visit and we verified it that day as we always do. However, a week later, the patient contacted the insurance company to change his provider and asked them to make it retroactive to the beginning of May, meaning it went back before the date of his visit with us. As a result, our visit was no longer covered. So he was insured with us that day but they changed the coverage after we had already provided the service and now refuse to pay.

Now either of these situations could be laughed off and corrected by a simple phone call. However, getting an intelligent being on the phone who will recognize the error and correct it is virtually impossible. My staff doesn't have an hour to spend on the phone being transferred multiple times to different departments, hopefully not getting disconnected in the process, and hoping to find someone who can look beyond the rejection comment in the computer to see what actually happened.

That's the state of our healthcare system today.

[97guns]

my brothers girlfriend is a big wig for a hospital and she said their write offs for uncollectable bills are sky high and continues to grow every year. she said there are tons of scammers trying to work the system, just last month they had a woman patient come in for help then the following week a male come in with the same name/member information.

[hamchan]

On the flip side I am pretty annoyed at all the things I've had to pay for because the doctor insisted I needed them even when I knew I didn't. Like being required to have a pregnancy test prior to a surgery when I had been celibate for two years. And having to pay for a second sleep study (those are expensive as all hell) not to mention go through that nightmare for a second time, because of the doctor's screw up. What made it worse was that I TOLD them ahead of time they were checking for the wrong thing, and lo and behold. I was right. I wish these kinds of things were isolated.

[disneysteve]

On the flip side I am pretty annoyed at all the things I've had to pay for because the doctor insisted I needed them even when I knew I didn't. Like being required to have a pregnancy test prior to a surgery when I had been celibate for two years.

Obviously you knew you couldn't be pregnant, but I can't begin to tell you how many times in the past 20 years a woman has sworn to me that she couldn't possibly be pregnant only to have her pregnancy test say otherwise. The reality is that patients lie. Patients forget. Patients are sometimes embarrassed to tell doctors the truth. There is no doctor around (at least not any doctor you would actually want to be treated by) who would take your word for something so critically important without verifying it to be true. That isn't an unnecessary test at all.

Of course, there is also the liability issue. If a doctor took a patient's word when they said they weren't pregnant and it turned out later that they were pregnant, that doctor would be destroyed by the malpractice case.

[hamchan]

So I should have to pay for an unnecessary test because other people lie? That seems fair.

[bigdaddybus]

So I should have to pay for an unnecessary test because other people lie? That seems fair.

Actually it does. Should DisneySteve have to take your word for it? I dont think so.


This arguement reminds me of sitting in court listening to birth parents trying to get their kids custody back. "I Dont use drugs, your honor!" hummmm.... the test shows you are positive for 4 out of the 9 drugs we test for.

I'm sure glad (for the kids sake) in both instances we dont take peoples word for it.

[disneysteve]

So I should have to pay for an unnecessary test because other people lie?

Yes you should. How is the doctor supposed to know who is lying and who isn't lying unless he does the test? Doctors can't just assume patients are telling the truth. The consequences of being wrong can be catastrophic.

[autoxer]

So I should have to pay for an unnecessary test because other people lie? That seems fair.

You are paying for the test, so that your doctors can protect themselves from the people that do lie. It's definitely not fair that people that commit insurance fraud drive up costs for everyone else.

[disneysteve]

You are paying for the test, so that your doctors can protect themselves from the people that do lie. It's definitely not fair that people that commit insurance fraud drive up costs for everyone else.

Just to be clear, I'm not talking about insurance fraud in my examples. When I ask a female patient if she might be pregnant and she says no but turns out to be pregnant when tested, there's no fraud involved. And my original two examples didn't involve any fraud either - just insurance companies that do things that don't make any sense.

[Joan.of.the.Arch]

Between what disnetsteve sees from insurance companies and what we "patients" also see, I believe we could overwhelm this website with stories. I know I have about four of them to share, yet my healthcare up to this point has been fairly scant. I have imagined I would just curl up in a ball and die if I am ever really sick and need my insurance. I know when I am sick, I do not have the focus to go through the obstacles the insurance companies throw in front of me for even simple matters.

[Jennsnoopy]

Try having one child with leukemia and another with cerebral palsy and epilepsy. We have good insurance and chasing insurance issues is a full time job and very draining as we deal with this while helping our kids with their medical issues. I have no idea what the answer is but it's a pretty complex problem for both practitioners and patients.

[hamchan]

Yes, I understand the doctor's perspective on this. But at the end of the the day I am still the one having to pay for a test to prove to the doctor something I already know so I can get a necessary surgery. Comparing that to court ordered drug tests is a pretty poor example. I am not on trial. I have done nothing wrong.

It frustrates me greatly that medical expenses are something I literally have zero control over. Even if I wind up owing thousands extra (as in my other example) because of a doctor's bad call, there is nothing I can do about it. There is also no transparency. Ever try to find out how much something is going to cost before you have it done? I've never been able to get so much as even a rough estimate.

[JoeP]

Whoever wrote the software rules that allow retroactive cancellation of insurance with pending claims should be publicly humiliated! Either that, or the insurance company should have a line item in their contract that puts financial responsibility on the policyholder if they do this.

[kv968]

When you have degrees offered just to be able to code and bill medical procedures, that should be a sign that things are a little out of whack if you ask me.

Medical Coding Specialist

[NetSkyBlue]

I had a minor procedure done, and I called my insurance company ahead of time to find out if it was covered, and what it would cost me out of pocket. I was told it WAS covered, I had a "specialist" co-pay of $60. So I had the procedure done, and the Dr's office asked for payment after. I said Huh? My insurance company said this was covered. Dr said noooo.... I called the insurance co again, and they said "we see where so and so told you that, but she was mistaken. She didn't realize that blah blah blah..." So I ended up owing over $700 for a procedure I was told would cost $60.

The thing that got me is, I didn't HAVE to go this route. There were other options available to me but I chose that one solely because I was told it was covered.