Single Payer, Please!

I’m going to rant for a minute about something that doesn’t have anything at all to do with World of Warcraft. You may want to skip it.

As you may know, I had surgery this past summer to remove a cancerous tumor from my leg. As cancer went, it was pretty low-key: I was only in the hospital for two days, I was able to walk more or less normally within a few weeks, and I didn’t need chemotherapy. I recently had my 3 month check-up MRI and there was no evidence of cancer. (There were, however, some weird spots that the doctor thinks were probably left over from surgery but which he wants to watch carefully. I’ll have another MRI at the 6-month mark – and another every 3 months for the foreseeable future – so we can see then if they are still suspicious.)

As you may also know, I live in the US. I am self-employed and I pay for my own health insurance. I opted for what is called a high-deductible plan: in other words, I pay less per month for health insurance, but it doesn’t kick in to pay much until I have already spent about $10,000 of my own money. It’s a plan that makes sense for reasonably healthy people who don’t get many colds but need to be protected against a nasty car accident or, say, cancer.

So although the total bill for my bout with cancer is $50,000+ and still climbing, I was theoretically only liable for about $10,000 of it. As always with insurance, it doesn’t quite work out that way – but suffice it to say that we had enough savings to cover our part, more or less. (We don’t have savings any more … but we’ll figure that out. We aren’t about to starve and we have a roof over our heads, which is more than I can say for some of our friends and family.)

But. Getting here – where most of the bills are paid – has been an amazing hassle, and it’s not near over yet. I’m going to set aside that first month where I was often completely unable to deal with people in a coherent manner (Vicodin FTW!) and focus only on the very recent past: namely, this morning.

I’ve been getting nasty letters from a collection agency in the mail for a few weeks about a bill from June that I paid in July. This is a bill for $78 that represents one office visit to my oncologist. I have had many of those to this office and paid them all promptly (I thought), but this one bill from June would not die.

The medical group that includes both my surgeon and oncologist maintains a billing website, so I checked my account there. It said that I had four unpaid bills, one of which the website also marked as paid and one of which I paid through their website and was marked as confirmed. (More on that later.) So I ditched that idea and called them.

I had already called the doctor’s billing office about this bill last week, but after waiting on hold for almost an hour, they hung up on me. (I believe it was an accident, but that hardly helps.) So today I called in at 8am, the minute the billing office opened. After 20 minutes on hold (I timed it!) with the electronic voice telling me that I was “Number. One. In the queue.” every 30 seconds, I got to talk to a person. Yay!

She looked up my account by name and birth date, then very helpfully let me know that I had been paying all of the bills with the wrong account number – which is why they were not applied to this bill. Had I waited, I would have started getting overdue notices on *all* of my visits to this doctor because they had all been paid to the wrong account number.

Wait, I said. How can I have two accounts? I am one person and I have only been seeing this doctor since June.

Ah, she explained: ‘account number; doesn’t mean account. I actually have seven account numbers because you get a new account number – helpfully listed on the bill in several places as “Account Number” – for each individual visit to the doctor. It’s actually an internal code that tells their computers which particular incident the bill is for.

If you pay with the paper mail voucher they send, or pay through their atrocious website, it uses the correct account number automatically. If you pay via online bill pay from a bank (as I do), then you have to change the account number with each bill or the payment will be posted to the wrong account. I filled out the account number when I created the account for bill payment at my bank, so I have been using an account number from the beginning of June. Every payment since then has not been applied to pay any bill.

Well what happened to those payments, I asked. Shouldn’t they have been refunded to me (thus tipping me off about the whole fake account number thing)?

No, she explained. If you overpay on any particular account number, you have to call in to have them cut you a refund check. Otherwise they will hold the money until your actual overall account (under your name and birth date) is fully paid … which wasn’t going to happen for me since the payments were not being applied to my actual bills.

Now that I had called in, she helpfully sorted out all my accounts, applied the overpayments to the two outstanding bills, and cut me a refund check for the remainder; it should be here in four to six weeks. Then she helpfully suggested that I pay more attention in the future. I wished her a good holiday season. (Yes, I am that mean.)

Next, I logged back into their website to match the account numbers on the two unpaid bills to the four (or possibly two) unpaid bills on the website. I found that:

  1. One of the marked-as-definitely-unpaid bills had been paid with the wrong account number and so was definitely unpaid.
  2. One of the marked-as-definitely-unpaid bills was to my surgeon (in the same medical group, remember) and not the oncologist. The payment used the correct account number and the money has been deducted from my account, so why this one is still marked as unpaid I have no idea. I haven’t gotten any overdue notices for this bill so I think I am going to leave it for now.
  3. One of the actual unpaid bills to the oncologist was marked as both paid and unpaid on the website. On the same line of the same table.
  4. The last of the bills, marked as both paid and unpaid, was the only one I paid through the doctor’s website instead of through my bank. This was the largest single bill – $8000+ – and the one I didn’t have enough in my online bank to pay in one swoop. So I put it on my Visa to pay off in chunks. (*cringe*)

Now here’s the thing. I paid with Visa through their website. This automatically filled in the right account number. They confirmed my Visa account at the time of payment. I know, because there is a handy confirmation number listed on the doctor’s website. The money was deducted from my Visa account at the same time; I saw the charge on the next Visa statement and have started to pay it off. So why, exactly, is this bill marked as unpaid in their system?

And more to the point, how long will it be before they send the collectors after me for that $8000+?

Unfortunately, that isn’t all for my health bill headaches today. I still need to call a different billing office about the bill they just sent me for visiting the ER a few weeks ago. My doctor sent me there to have an ultrasound of my leg; he thought I might have a blood clot and it was Friday after 5pm, after his normal ultrasound place closed for the weekend. Although the chances that I had a blood clot were small, and the chances that if I did it would break loose over the weekend were small, if it did it might have caused a stroke or death. He was very emphatic that I have the ultrasound that night at the ER.

So Saturday the bill for the ER came in. $650 with no insurance coverage – it says that my insurance company rejected the claim. Now I have insurance and I know that this is covered, and even if it wasn’t they would have accepted the claim and then declined to pay any of it – they’ve done that before. So it seems likely that the hospital messed up the claim. I wouldn’t normally jump straight to that conclusion, but I spent nearly as long working out the insurance info that night as I did waiting for the ultrasound tech. It eventually took three billing staff and one on-call billing supervisor to get the information entered. Apparently I have weird insurance.

(Note to those who may not know: pretty much any non-employer-provided health insurance in the US is considered weird.)

So today I get to call the ER and try to get them the correct information over the phone when I failed to do it in person before. My one hope: that the staff working Monday during office hours has more experience with my insurance company than the staff working Friday night did. My other hope: that they agree to hold off on the bill until this is straightened out.

So.

So why do I say I wanted a single payer system? What does one doctor’s office with screwed up billing and one mistake with my insurance info have to do with reforming the entire health care payment and insurance model? Because this isn’t unusual. This is a description of my entire cancer experience – hell, my entire lifetime health care experience! – from beginning to end. I haven’t even touched on lost records or my mental health coverage (none – and I’m bipolar) and I don’t really think I want to.

The fact is that profit drives the core of this mess, and the private insurance industry drives the need for profit.

Gah. This is just a rant after all. I’ll just wrap up by saying this: If you are in the US, and especially if you don’t have employer-provided health insurance, the best you can do is pray for health.

I will be praying with you. I knew it was bad. I had no idea how bad it really was until I had to deal with it myself.

9 thoughts on “Single Payer, Please!

  1. BluegrassGeek

    The “account number for each visit” thing is actually pretty common for hospitals. Most folks have one number that identifies them as an individula, and another number for each specific visit (so they can easily find out when you had Test X or what was given to you during Procedure Y).

    However, that doesn’t excuse their billing department from being so lazy they couldn’t see your overpayments and apply them to the correct accounts. Or at least contacting you to let you know you’d overpaid that one bill. That’s the shady part, in my mind.

    And I agree, I’d have rather had single-payer insurance. If Congress had simply extended the same insurance that military veterans & members of Congress themselves get, to every US citizen, it wouldn’t even require a major new system be developed. The existing system would simply have to be expanded to handle more insured individuals.

    As to your ER visit, yeah, likely they didn’t code something correctly*. Commercial insurance is picky as hell, exactly so they can get by with denying those claims. Hopefully the ER billing staff can help with that. I know the hospital I work for is good about that because they want to be paid for that treatment. And insurance is more likely to do that than someone forced into collections.

    * There are actually different billing codes for how a medicine is given to you and in what order they were given. Getting that wrong can be the difference between a $1000 bill vs a $10,000 dollar bill!

  2. Toka

    This so much this! I am tired of the patched up system we have and it is insane that crap like this has to happen. We are a civilized country (or at least claim to be) so we should do the humane thing and make sure all our people get health coverage.

  3. Suzanne

    I think I might go give my Ontario Health Insurance Card a hug. Good luck getting that sorted out. It sounds akin to my worst nightmares of billing hell.

  4. Adrian

    Yay for public healthcare. Get sick, get help, go home. No bills. I love Australia. The account number “design” of the billing system is the most stupid thing I’ve ever heard, the people who designed this should be forced to use it themselves as punishment. Surely the medical company must have 90% of their accounts in overdue status all the time.

  5. Saphia

    I think it’s really disgusting that we have for-profit companies in charge of our health in this country. That being said, it’s not just private payer insurance. We have insurance through our employer and after my son was born premature, we had thousands of dollars in bills for his NICU stay and my week+ long stay in the hospital. I had to argue with one company that the reason I wasn’t paying their bill was because they had not filed it with my health insurance and they kept insisting that I had never given the hospital my insurance information in the first place. – even though I had pre-registered with the hospital a month before my son was born, which was the requested thing for patients to do by the hospital. Oh and even though I’ve been to this hospital several times over the past 15 years and have never changed insurance in all that time. and even though the same hospital DID have my insurance information for another bill. I like France’s ID card that tracks your doctor visits, payments, drugs that are prescribed, etc. all in one spot.

  6. wodun

    “So why do I say I wanted a single payer system? What does one doctor’s office with screwed up billing and one mistake with my insurance info have to do with reforming the entire health care payment and insurance model? ”

    Sorry but that wont fix the problem. Bureaucracy wont disappear. It isn’t so much that health care providers need to make a profit as it is that they are forced to code every interaction. Coding will not disappear with single payer. The government will want to track everything.

    Could it end up simpler for the individual? Maybe. But the costs of bureaucracy and the tracking of interactions will not go away.

    I hate health insurance companies for other reasons and unfortunately for us regular people, things are not going to be getting better any time soon.

  7. Gorman Ghaste

    Yes, single-payer health insurance would be cheaper and less complicated than what we have now.

    <–uninsured, providing elder care for a family member

  8. Azzrazzah

    I’m dealing with the same thing but work providied insurance. I have a bum back.. at first Blue Cross/Blue Shield said I wasn’t covered. so I paid with visa. Then i called my insurance person at work and she said I was covered. Long/short of the matter. The whole insurance industry needs an Enema. I now have credit with my doctor’s from this incident. So I guess I can go in and get Umteen million massages or even Chiro work. I’m hoping they cut me a check sometime rather than just the credit. Could use the cash more at this point. The bastards once they have your cash; they realy hold onto it with tooth and nail…

  9. Ian

    Sorry to hear about your troubles Mania. It just makes me realize how lucky I am too live in the uk where everyone gets health care. I’m a cancer survivor and am doubly lucky to a)be here and b) live here.

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