February 11, 2011
The rotten US health care system-part 4
In the previous post in this series, I said that in order to get a simple and obvious mistake corrected, I had to make 17 phone calls to the hospital's billing office, 15 calls to my doctor's office, 9 calls to the insurance company billing office, and 4 calls to the radiologist's billing office.
What is also noteworthy is the large number of people I spoke to during this saga. In my calls to the hospital billing office, I spoke with Jennifer, Sherry, Sharon, Linda, Megan, Michelle (twice), Heather (twice), Kim (twice), Sarah, Mia, Amy, Caroline, David, and Michael. In my calls to the insurance company I spoke with Dema, Dennis, Pam, Vicky (thrice), Linda, Lynn, and one person whose name I forgot to note. In my calls to the radiologist's billing office I spoke to Debbie, Marva, Debra, and Colette.
All these people are employed just to deal with billing issues and customers who have questions and problems with billing. When you consider all the people and time involved in this one simple case, is it any wonder that the bureaucratic costs are so large in the private health insurance system in the US?
My conversations with the people in the billing offices of the hospital and radiologist's office and the service call center of the insurance company were mostly cordial and friendly. They seemed to be genuinely trying to help me but they were all stuck within this awful system. The only exceptions were David in the hospital billing office (who seemed like a smart-alecky know-it-all who was unfriendly and seemed to be annoyed at my persistence and kept insisting that my efforts to rectify the error would fail) and the 'coder', the person in the hospital billing office responsible for putting the code numbers on the treatments that were submitted to the insurance company.
This coder in the hospital billing office was clearly a key gatekeeper to the process and is a shadowy and mysterious person. Early on I had found out that the billing code for a bone density scan for someone with osteoporosis was 733.00 and that for a routine bone density scan was 733.09 and I used this information in all my calls to try to get the code on my insurance claim changed from the former to the latter. I was told at one point that the coder felt that I had no business knowing the code numbers for the various diagnoses and anyway that changing the code number would not influence the insurance company. I responded that it was not the hospital coder's business to decide what my health insurance company would do and that she should simply put the correct code and leave it at that. I asked to speak with the coder but apparently no one speaks directly to this mysterious and august person. I was amused but also irritated at the idea that I, the patient who was responsible for paying the bills, should not be told how the diagnoses should be coded. It seems to be part of the plan to keep us in the dark as to how the system works so that we meekly accept their decisions.
One of the lessons that I hope people will take from this is that in order to deal with this bureaucracy, one needs to be really patient and persistent. Also, you have to keep your medical records and know what they say. I have also learned when dealing with the customer service departments of any business to keep notes of the date, time, the person spoken to, and the gist of each call. Since almost every time you get a different person, you cannot assume they know the history of your case even if it is on their computers and it helps to quote the results of previous conversations to them, because when you seem knowledgeable, they respond better.
I am also very polite to the people I speak to since they are not the problem, although I am sure that at times my weariness and exasperation with the system came through in my voice. The people who work in these call service centers are also stuck in this system and I am sure that they get yelled at a lot by angry people. Most of them sympathize with you and want to help but are limited in what they can do, so it is not fair to vent at them. It is the people in the higher levels of the insurance companies and hospitals, the people we do not usually encounter, who are the ones who try to find ways to deny coverage and thus increase their institutions profits, as Michael Moore's documentary Sicko so clearly demonstrates. They are the villains.
I recount my experience in such detail as an illustration of what people have to sometimes go through. The sad fact is that it is probably not unusual. In my case, I was finally successful at getting the error corrected and the bills paid by the insurance company. But many people will end up getting stuck with the bill, either because they got fed up with the runaround or were paralyzed by the Byzantine nature of the process or did not have the time to waste on all these phone calls or were overawed by the system. Even I was tempted at times to say the hell with it, pay the bill, and move on. But given my hatred for this system, I was determined to not let it defeat me, and so gritted my teeth and fought it all the way.
It is important to realize that this kind of thing would almost never happen in a single payer system of the kind found in most developed (and many developing) countries. In those systems the patient deals only with the health care provider and all these tedious bureaucratic matters are negotiated behind the scenes between the single payer entity and the health care providers out of sight of the patient. As far as the patient is concerned, you go and see a doctor and the doctor treats you according to their guidelines and that's it. You do not have to deal with any billing office unless you have some kind of supplementary private health insurance system in addition to the single payer one.
The solution to the problems that plague the US health care system is to adopt a single payer system and eliminate the private health insurance industry except as a form of supplemental insurance. The easiest way to do that would be to extend Medicare to everyone. The private profit-seeking health insurance industry is a parasite that sucks the life out of the health system by diverting huge sums to the shareholders and top executives and to pay the bloated bureaucracy needed to keep track of all the unnecessary paperwork. It has to go.