We have heard forever that we have to have health insurance because health care costs are too high.
How high became painfully clear to me in a snafu I am still trying to dig my way out of, a snafu caused by a system way too complex for a person of average intelligence to comprehend.
It all started when I got a bill from a hospital saying I owed $4,200 and change. It did not say what it was for.
A check with the hospital indicated my insurance paid for a procedure in 2012 and I never heard any more for three years. But then the insurance company decided it didn’t like what they did and wanted their money back – two years after the procedure. It took another year for a bill to reach my mailbox.
Huh? How does that work? Can I buy a new car, drive it for two years and then demand my money back because it got dirty? Or I didn’t like the color any more?
“Oh, they do it all the time,” I was told. No, the hospital did not send them a check for $4,200. The insurance company just deducted that amount from other payments.
Then I got several other bills for similar incidents and finally got a printout of the first problem. I was told the latter ones were still in negotiation, that the 3-year-old issue was the only one still unresolved.
That printout said the insurance paid a little less than $800 for the procedure and the hospital wrote off the balance of $4,200 and change. That was to the penny the amount the hospital had billed me for.
Turns out in the end, the claim was denied because my doctor at the time was a few days late getting justification for the procedure to them. No, it’s not your fault, you are not responsible, they finally told me.
Why didn’t they decide that three years ago?
I have been told that’s how it works. You have a procedure and your insurance – Medicare and a supplement plus a company policy in my case – and the hospital then writes off the difference.
That means if you had walked in the door with no insurance and said you would pay out of pocket, your bill for that procedure would have been right at $5,000.
The hospital can stay above water for $800 but if you don’t have insurance, all of a sudden, they need $5,000.
That’s a big reason health care costs so much.
I have since had to spend inordinate amounts of time talking with various insurance people on that and a host of other snafus.
For one thing, I had been on Care Improvement Plus for my Medicare supplement. As of the first of the year, United Healthcare bought out Care Improvement.
I had gotten that policy specifically because I had been diagnosed as a diabetic. It was designed for people like me.
But now United Healthcare has no record of my being diabetic. I didn’t change healthcare insurers. They changed ownership.
After repeated phone calls and visits to my primary care physician’s office and more calls to the insurance company, we got that cleared up. Now they said they could not find my doc on their list of providers. He had always been there on Care Improvement but when they changed ownership, he went away.
I had an appointment with a specialist the next day and, just for fun, I asked them to check his name as well.
Nope, he’s not there either.
I called his office and, after a few minutes, they called me back. No, he is there and has been all along.
Whether there is a problem with my primary care physician, I have no idea. It could be just the lady I dealt with didn’t know how to find him.
We don’t need more insurance. What we really need is an insurance plan that protects us from insurance plans.