Our health care system is ridiculous. It might be more correct to say our health care billing system is ridiculous. I don't have all the answers on how to fix it, but I'm pretty sure that adding more government bureaucracy to the system is not the answer. Let me tell you my health care story for the week.
The other day I sorted through my "junk" mail and found a very plain envelope that ended up being a bill from a firm that bills for doctors and PAs and apparently NPs. From this point on I will refer to it as The Billing Firm. This was for my emergency room visit at the end of July. The bill was dated September 26 or something like that. Not being very familiar with the health care system, my first thought was that the bill might be bogus/insurance fraud. Why would it be coming months later? The bill said they had billed my insurance company, but then they sent me this bill too. Why is it that the hospitals bills you for stuff, then you get billed to read the X-rays, and then the doctor bills you? Aren't they all employed by the hospital? Can't the hospital do the work of consolidating those fees?
I check my online insurance account, and they don't show any record of The Billing Firm ever sending this bill. I'm still suspecting fraud, although they do have the treatment date and time correct. So I call The Billing Firm. The tell me they've sent the bill to my insurance company twice with no response from them either time, so they sent the bill to me now. I tell them I don't see any record of that from my insurance company, and I ask them what insurance company they're sending the bill to. They say they can't tell me (I think because of security reasons). They ask me to tell them who my insurance company is. I say I can't tell them because I don't even know if this bill is legitimate. How do I know they're for real? They say of course they're for real because they have the correct treatment date and doctor's name. Yeah....I don't think that proves anything. They could probably get that info from lots of places, particularly if they're professional scammers. So, I say that I will call my insurance company to see what the deal is.
I call the insurance company (waiting on hold is standard practice - for all of these calls including to the The Billing Firm). They say they don't have any record of this billing. Yah, I know - I already checked online. Where is The Billing Firm sending the bill? I have no idea because they won't tell me. Well, they shouldn't be billing Insurance Company Name, they should be billing Other Insurance Name. OK.......and what's the address for that? Just tell them to bill Other Insurance Name. OK....can I tell them to call you? Yes, I can. Great. What number should I have them call? They give me the number. Is this normal that the doctor sends a bill separate from the hospital? Yes. Okey dokey, it's likely legitimate then. I close the call.
Back to The Billing Firm. After a shorter time on hold this time, I talk to another customer service person. I tell them they need to bill Other Insurance Name. Do I know the address? No I don't, but I can tell you what number to call to get the correct address. Oh, they're sorry, they can't call that number because they're only an incoming call center, and they can't make outgoing calls. WHAT?!?! Seriously?! Yes, seriously. Huh. I suggest (tongue in cheek) that maybe that's why my insurance company hasn't responded to The Billing Firm because maybe my insurance company can't make outgoing calls either. :-) Oh no, they assure me they talk to insurance companies all the time. OK.....so there's absolutely NO ONE one at your business that can make ANY outgoing calls? Not even one person? Well, there is, but she has like a hundred cases on her desk and yada yada yada.......you know, she's busy. Huh. At that point I don't know what to say, so I sit in silence while thinking that they really don't want their money very badly if they're not willing to make any outgoing calls to get it.
After several seconds of heavy silence, the customer service person offers to verify my insurance information. Good idea. No, the previous time I called we didn't get that far even though the note in my file says we did. I give her some details from my insurance card that she needs. It's all different from what they have on file. How do they get wrong information like that? Supposedly the hospital gives them the information, so the hospital must have sent the wrong information to the billers. Huh. So how can I even trust that they are billing for the correct procedures/care that was provided? I'm quickly assured that's for sure correct. Right......that does not provide any comfort. The description of what they're billing me for is fairly close, so it probably is correct, but personally I only give it a 50/50 chance. The hospital seems to be billing my insurance company just fine, so who knows what the real deal is. The Billing Firm says they'll try to re-submit with this new information, and I can disregard the bill at this time. OK, great. Thanks. Good luck with your billing. Bye.
How did it ever get this bad? What are the root causes of so much bureaucracy surrounding our health care system? Is it insurance companies? Is it because of medicare and medicaid where the hospitals have to document for the government every little tiny thing they did? More research must be done in order to know the root cause. All I know is that the 10 minutes the nurse practitioner spent with me was more than half the cost (maybe even two thirds the cost) of that three hour emergency room visit. I went to the Occupational Therapist ten times for a total of 5 or 6 hours for less than it cost me to see the NP for 10 minutes in the ER. My heart goes out to all of you who have to frequently deal with our health care system and its billing methods. It is ridiculous. It almost tempts me to get rid of my insurance plan all together. Oh wait, if I do that, the government is going to tax me......so either I deal with insurance bureaucracy, or I deal with IRS bureaucracy. Such a hard choice!
P.S. Who knew I was so much into challenging authority? First the police, and now this.