The truth is out. Healthy people suck.
Every time somebody wants to ban something fun--like cigarettes, cigars, liquor, or Big Macs--somebody usually mentions health care costs. That's why it's not just their own business, the busybodies assert, because all of us pay for the unhealthy lifestyles of some through greater health care expenditures.
Well, guess what? It ain't so. Turns out the cost-benefit analysis actually favors fat drunks who smoke.
Why?
Because the health care cost for dead people is zero. Healthy people ultimately use more health care because they live longer, according to a new Dutch study published in the journal Public Library of Science Medicine. It says that because obese people and smokers live for shorter periods of time, they are cheaper to treat in the long run. "Preventing obesity and smoking can save lives, but it doesn't save money," say the study's authors.
For the record, I don't smoke.
Showing posts with label health benefits. Show all posts
Showing posts with label health benefits. Show all posts
Tuesday, February 5, 2008
Knock on Wood.
About a week ago, I sent the hospital a check for $28.73, which they say is the balance due for, you know, that thing back in October. I'm not really sure, from the statements and EOBs why $28.73, but $28.73 is a number I can easily pay just for peace of mind. Is it really over? Let's say yes.
If you have followed this saga, you may want to hope RCN (my broadband provider) gets religion and decides not to screw me after all, or you'll be reading another one of these tales of woe.
If you have followed this saga, you may want to hope RCN (my broadband provider) gets religion and decides not to screw me after all, or you'll be reading another one of these tales of woe.
Wednesday, January 23, 2008
The Other Shoe Has Dropped, Partially
So the phone rings and I answer it. It's a robo-dialer from the hospital.
Readers of this space will know "the hospital" from my medical billing saga.
The robo-dialer identifies itself as the hospital's billing department. Normally I would not cooperate with a robo-dialer, but I knew what it was about so I held on. Naturally, the person who picked up asked me what I wanted. "You called me," I replied. The representative figured it out. According to her, with the payment Blue Cross made yesterday, I owe the hospital something like $20. I don't know why or for what, and will wait for the bill, but if at this point $20 is the price for an end to this saga, I will pay it.
Readers of this space will know "the hospital" from my medical billing saga.
The robo-dialer identifies itself as the hospital's billing department. Normally I would not cooperate with a robo-dialer, but I knew what it was about so I held on. Naturally, the person who picked up asked me what I wanted. "You called me," I replied. The representative figured it out. According to her, with the payment Blue Cross made yesterday, I owe the hospital something like $20. I don't know why or for what, and will wait for the bill, but if at this point $20 is the price for an end to this saga, I will pay it.
Tuesday, January 22, 2008
The First Shoe Has Dropped.
Referring you back to the on-going saga of my struggle to get some medical bills straightened out, I received the new Explanation of Benefits statement from Blue Cross today. The amounts and changes shown are a little bit confusing, but they appear to have made an additional payment to the hospital, which should make the hospital happy. The other shoe is whether or not it makes the hospital happy enough. The saga will only truly be concluded when the hospital acknowledges that it has received all the money it expects to get.
Even to the hospitals, insurance companies and others who are in the center of this thing, even to them it must all seem mysterious at times. The money flows, the money doesn't flow, but nobody quite knows where the spigot is.
Anyway, I am still cautiously optomistic.
Even to the hospitals, insurance companies and others who are in the center of this thing, even to them it must all seem mysterious at times. The money flows, the money doesn't flow, but nobody quite knows where the spigot is.
Anyway, I am still cautiously optomistic.
Friday, January 11, 2008
I Am Cautiously Optimistic
I am cautiously optimistic that the health care billing problem I vented about yesterday has been resolved.
I finally got someone at Blue Cross to, in the jargon of customer service, take ownership of the problem. I think it was a combination of getting someone who has that attitude (the luck of the draw) and finally having enough information myself to point him in the right direction. He was able to compare the diagnostic codes used on the physician's bill to the codes used by the hospital on the claim that was being denied to figure out what the hospital did wrong.
He told me and then I told the hospital that a check was being cut and adjusted paperwork was being issued. The hospital's "financial representative," though still dyspeptic, agreed to lay off for 15 days.
The Blue Cross representative today, in addition to being genuinely helpful, could not have been more pleasant. Without prompting, he began to refer to himself and the others in his job as "patient advocates." If the first person I spoke to at Blue Cross had felt the same way, we might all have avoided a lot of time and trouble.
I also had a couple of nice conversations with the hospital's pathology lab. The doctor was great too. The representatives of the hospital's billing department, not so good.
Not surprisingly, all evidence points to the mistake having been made by ... the hospital's billing department! The people who have been the least cooperative and most unpleasant as I have tried to resolve the problem probably caused it in the first place.
One interesting bit of evidence: when I talked to the hospital's billing department, I made sure they understood that the dispute was about the pathology lab line item on the hospital's bill, not the pathologist's direct charges. She insisted that all the hospital did was pass through coding provided by the pathology lab, so it had to be fixed there. I repeated that to my contact at the pathology lab and she said that's not true.
The main lesson remains that this is exactly why health care is so expensive. More precisely, this is the part of health care cost that is pure waste. Other lessons are that it always works better to be nice and friendly with people, even and perhaps especially in situations that might become adversarial. It's a lot more effective and a lot more pleasant and is, quite possibly, more effective because it is more pleasant. Most of the time, people can figure things out if they'll just try.
But before I get all lollipops-and-unicorns, let's wait and see the EOB. I've been wrong before.
I finally got someone at Blue Cross to, in the jargon of customer service, take ownership of the problem. I think it was a combination of getting someone who has that attitude (the luck of the draw) and finally having enough information myself to point him in the right direction. He was able to compare the diagnostic codes used on the physician's bill to the codes used by the hospital on the claim that was being denied to figure out what the hospital did wrong.
He told me and then I told the hospital that a check was being cut and adjusted paperwork was being issued. The hospital's "financial representative," though still dyspeptic, agreed to lay off for 15 days.
The Blue Cross representative today, in addition to being genuinely helpful, could not have been more pleasant. Without prompting, he began to refer to himself and the others in his job as "patient advocates." If the first person I spoke to at Blue Cross had felt the same way, we might all have avoided a lot of time and trouble.
I also had a couple of nice conversations with the hospital's pathology lab. The doctor was great too. The representatives of the hospital's billing department, not so good.
Not surprisingly, all evidence points to the mistake having been made by ... the hospital's billing department! The people who have been the least cooperative and most unpleasant as I have tried to resolve the problem probably caused it in the first place.
One interesting bit of evidence: when I talked to the hospital's billing department, I made sure they understood that the dispute was about the pathology lab line item on the hospital's bill, not the pathologist's direct charges. She insisted that all the hospital did was pass through coding provided by the pathology lab, so it had to be fixed there. I repeated that to my contact at the pathology lab and she said that's not true.
The main lesson remains that this is exactly why health care is so expensive. More precisely, this is the part of health care cost that is pure waste. Other lessons are that it always works better to be nice and friendly with people, even and perhaps especially in situations that might become adversarial. It's a lot more effective and a lot more pleasant and is, quite possibly, more effective because it is more pleasant. Most of the time, people can figure things out if they'll just try.
But before I get all lollipops-and-unicorns, let's wait and see the EOB. I've been wrong before.
Thursday, January 10, 2008
My Continuing Adventures in Health Care Land.
My problem with a routine health insurance claim, that I wrote about in late November, has not been resolved after all. There have been developments, but nothing has really changed. The hospital says I still owe nearly $2,000 in lab charges that their paperwork calls "Pathology Lab" but Blue Cross is calling uncovered "Routine Lab Services."
I believe Blue Cross should pay $1,500 of that and I’m on the hook for the remainder. I suppose I could have gone ahead and paid the part I know I will owe when all is said and done, but why should I? The people who want the money owe me a satisfactory resolution of the problem first.
So far, no one has explained to me why these services are considered “routine” and not covered, when they were an integral part of a covered procedure. In fact, everyone has said they should be covered and there must be a mistake. Then everyone has told me the mistake is not theirs. Each person has told me where they believe the mistake was made and what I should do to resolve it. I have done what they have told me to do in a timely manner. It hasn’t helped.
The parties in this thing are me, Blue Cross, the hospital, the hospital’s pathology lab, and the doctor who performed the procedure. The pathology lab is part of the hospital, but handles its own billing and bill coding. (Everyone agrees the problem is probably a coding error.) The doctor, of course, is also nominally independent but has been on staff at the hospital for 20 years.
I’m not naming the hospital, pathology lab or doctor because that’s not why I’m posting this. I think what I’m experiencing is universal. I mention Blue Cross only because it’s important to know that my benefits provider is a major one, not some fringe company. The hospital is a big one too, part of a large, not-for-profit medical corporation, and is in my plan’s preferred provider network, so they’re supposed to all be able to play nice together. It’s not happening that way.
The problem is that I keep getting a run-around. I’m willing to do the work to solve this problem, but I can’t get access to it. I have to trust other people, whose own access is often limited. No one wants to own the problem. I’ve spoken to everyone except the pathology lab at least once. It became appropriate for me to talk to the pathology lab three days ago, but since then the person to whom I need to talk has been out sick.
Blue Cross has been okay. They could be better. They could actively help me track down the problem. They, like everyone else, have demonstrated a certain systemic incompetence. Here is an example. Today I received what is, in effect, a dun letter from them. The letter says, “If you have any questions, please call us at the telephone number shown at the top of the page.” I called that number, provided all of the necessary identification data, and was told I had called the wrong office. I go through this exact same scenario every time I talk to them. Why can’t they just give me the correct number in the first place? Why give me any number at all if they are going to give me the wrong one?
Why don’t I just call the right number? How do I know what it is? I call the number they tell me to call. They eventually give me a different number and I call that. Is that one always the right number? I’ll keep experimenting, of course. Eventually I do get to the right person, only to be told I have to talk to the provider, i.e., the hospital. Then the hospital tells me to talk to the doctor.
I have talked to the doctor, who has been very helpful and accessible and has done everything I have asked him to do. This is a highly-trained, long-experienced, board-certified specialist who is spending his time to help resolve a patient’s billing problem. The problem isn’t even with his charges, yet he has been a lot more willing to help than the people with customer service in their job titles.
The hospital, where I’m confident the problem is, has not been cooperative. Their customer service people have been terse and rude. Their solution was, “the doctor has to talk to the pathology lab.” The doctor did talk to the pathology lab, but only about the charges the pathology lab billed to me directly, which are fine. That was billed correctly and has been paid in full. The problem is with the pathology lab charges that are being billed by the hospital. I explained this but, hey, he’s a gastroenterologist. Now he wants me to talk to the pathology lab directly. The person he told me to talk to is out sick and, of course, no one else there can help me.
In each case, with each conversation, I have provided all of the information I have. I answer every question I am asked. It hasn’t helped. I feel like the problem is in a box that I can’t open. The people who should be able to open it keep passing the buck to someone else.
What I want someone to say is, “I’m going to track this thing down and figure it out for you.” The doctor is the only one, other than me, who has tried to do that but he proved inadequate to the task. That’s not a criticism, as his access to the box is only slightly better than my own. Both the hospital and Blue Cross have customer service departments that are supposed to provide, well, customer service, but have, in fact, just passed the buck. Blue Cross, at least, has been unfailingly nice about it.
One of those customer service departments should be in a position to knock heads, find out what happened, explain what happened to me and to the other participants, and then fix it. Even if the final outcome is, sorry, those charges really aren’t covered and here’s why, that would be something.
The point of all this, of course, is that this is why health care costs so much. There is a sum of close to $2,000 out there that hasn’t been paid, for a service that was provided now more than three months ago. The service was fine, the billed amount, so far as I can determine, is appropriate, but an administrative glitch has kept that money from being collected for more than three months. Time is money. If I, as a service provider, know I’m going to have to wait several months to receive payment for the service I provide, that’s going to be reflected in my prices. Multiply that by millions of similar incidents and you have billions of wasted dollars. The extra money isn’t paying for medical services, it’s paying for debt service, and for customer service that is provided in name only.
There’s an irony in this. I’m working on an employee development project right now for a client. The subject? Improving customer service.
I believe Blue Cross should pay $1,500 of that and I’m on the hook for the remainder. I suppose I could have gone ahead and paid the part I know I will owe when all is said and done, but why should I? The people who want the money owe me a satisfactory resolution of the problem first.
So far, no one has explained to me why these services are considered “routine” and not covered, when they were an integral part of a covered procedure. In fact, everyone has said they should be covered and there must be a mistake. Then everyone has told me the mistake is not theirs. Each person has told me where they believe the mistake was made and what I should do to resolve it. I have done what they have told me to do in a timely manner. It hasn’t helped.
The parties in this thing are me, Blue Cross, the hospital, the hospital’s pathology lab, and the doctor who performed the procedure. The pathology lab is part of the hospital, but handles its own billing and bill coding. (Everyone agrees the problem is probably a coding error.) The doctor, of course, is also nominally independent but has been on staff at the hospital for 20 years.
I’m not naming the hospital, pathology lab or doctor because that’s not why I’m posting this. I think what I’m experiencing is universal. I mention Blue Cross only because it’s important to know that my benefits provider is a major one, not some fringe company. The hospital is a big one too, part of a large, not-for-profit medical corporation, and is in my plan’s preferred provider network, so they’re supposed to all be able to play nice together. It’s not happening that way.
The problem is that I keep getting a run-around. I’m willing to do the work to solve this problem, but I can’t get access to it. I have to trust other people, whose own access is often limited. No one wants to own the problem. I’ve spoken to everyone except the pathology lab at least once. It became appropriate for me to talk to the pathology lab three days ago, but since then the person to whom I need to talk has been out sick.
Blue Cross has been okay. They could be better. They could actively help me track down the problem. They, like everyone else, have demonstrated a certain systemic incompetence. Here is an example. Today I received what is, in effect, a dun letter from them. The letter says, “If you have any questions, please call us at the telephone number shown at the top of the page.” I called that number, provided all of the necessary identification data, and was told I had called the wrong office. I go through this exact same scenario every time I talk to them. Why can’t they just give me the correct number in the first place? Why give me any number at all if they are going to give me the wrong one?
Why don’t I just call the right number? How do I know what it is? I call the number they tell me to call. They eventually give me a different number and I call that. Is that one always the right number? I’ll keep experimenting, of course. Eventually I do get to the right person, only to be told I have to talk to the provider, i.e., the hospital. Then the hospital tells me to talk to the doctor.
I have talked to the doctor, who has been very helpful and accessible and has done everything I have asked him to do. This is a highly-trained, long-experienced, board-certified specialist who is spending his time to help resolve a patient’s billing problem. The problem isn’t even with his charges, yet he has been a lot more willing to help than the people with customer service in their job titles.
The hospital, where I’m confident the problem is, has not been cooperative. Their customer service people have been terse and rude. Their solution was, “the doctor has to talk to the pathology lab.” The doctor did talk to the pathology lab, but only about the charges the pathology lab billed to me directly, which are fine. That was billed correctly and has been paid in full. The problem is with the pathology lab charges that are being billed by the hospital. I explained this but, hey, he’s a gastroenterologist. Now he wants me to talk to the pathology lab directly. The person he told me to talk to is out sick and, of course, no one else there can help me.
In each case, with each conversation, I have provided all of the information I have. I answer every question I am asked. It hasn’t helped. I feel like the problem is in a box that I can’t open. The people who should be able to open it keep passing the buck to someone else.
What I want someone to say is, “I’m going to track this thing down and figure it out for you.” The doctor is the only one, other than me, who has tried to do that but he proved inadequate to the task. That’s not a criticism, as his access to the box is only slightly better than my own. Both the hospital and Blue Cross have customer service departments that are supposed to provide, well, customer service, but have, in fact, just passed the buck. Blue Cross, at least, has been unfailingly nice about it.
One of those customer service departments should be in a position to knock heads, find out what happened, explain what happened to me and to the other participants, and then fix it. Even if the final outcome is, sorry, those charges really aren’t covered and here’s why, that would be something.
The point of all this, of course, is that this is why health care costs so much. There is a sum of close to $2,000 out there that hasn’t been paid, for a service that was provided now more than three months ago. The service was fine, the billed amount, so far as I can determine, is appropriate, but an administrative glitch has kept that money from being collected for more than three months. Time is money. If I, as a service provider, know I’m going to have to wait several months to receive payment for the service I provide, that’s going to be reflected in my prices. Multiply that by millions of similar incidents and you have billions of wasted dollars. The extra money isn’t paying for medical services, it’s paying for debt service, and for customer service that is provided in name only.
There’s an irony in this. I’m working on an employee development project right now for a client. The subject? Improving customer service.
Thursday, November 29, 2007
My Recent Adventure In Health Care Land.
I had a colonoscopy about two months ago. If you are over age 50, you should have one too.
Happily for all of us, that’s not what this is about. There will be no further mention of my colon in this post.
The procedure is routine. Mine was performed at a hospital here in Chicago, by a gastroenterologist who happens to be the Gastroenterology Section Chief at that hospital. He was recommended by my internist. It was out-patient, in and out in a few hours. Everything was normal. Routine, routine, routine.
My health insurance is with Blue Cross Blue Shield of Illinois (BCBSIL). As I am self-employed, it is an individual policy. I’ve had it for about 20 years, ever since I came to Chicago. It is a Preferred Provider Organization (PPO) plan so I can see any doctor, but I have to use in-network hospitals. There is a deductible and, after that, it pays at least 80 percent of covered charges.
For purposes of this post, that’s enough detail. The coverage is pretty standard, nothing exotic, and it’s not cheap.
My plan does not, as some do, require advance approval for this type of procedure, but I called BCBSIL anyway to make sure everything was covered. They assured me it was.
I’m a pretty healthy guy, but I’ve had enough medical care of various kinds over the years to know the drill with billing and insurance. Everybody gets your insurance information and sends their bills first to the insurance company, which pays the amount it believes it owes. Then the providers come after you for the rest. You expect to receive separate bills from the doctor and hospital, maybe another one for outside lab services, and maybe one or more from other practitioners, such as a pathologist or anesthesiologist.
When the bills start to come, the easiest way to process them is to take the Explanation of Benefits (EOB) reports from the insurance company and match them up with the provider invoices. You should have an EOB for each bill and all of the numbers should agree, including the number you care most about, the amount you owe.
This is my first gripe. When I take my Buick in for repairs, I don’t get separate bills from the mechanic, garage, and parts department. If the work is covered by warranty, I don’t get another envelope full of paperwork about that. I get one bill and it says, “here’s what we did, here’s how much you owe us.” There is no real reason health care can’t be just as straightforward.
But it isn’t.
Although everything should have been routine, in the case of my recent procedure there was a billing problem. BCBSIL disallowed almost $1,500 in lab charges that the EOB labeled “routine lab services.” I immediately called BCBSIL and the representative explained that “routine lab services” are not covered by my policy. I countered that the lab services were not “routine” but were a necessary part of a covered procedure. She agreed that what I described sounded like something which should have been coded as “medical lab” or “surgical pathology,” not “routine lab services,” but at any rate they could not change the coding. That would have to be done by the provider who submitted the charges.
Gripe number two. I maintain that “customer service” in most businesses means “solve the customer’s problem,” but that’s not what it means in the health care business. The ball was back in my court.
So I called the hospital. Their representative agreed that it sounded like a coding error. She conferred with the hospital’s coding department and everyone seemed to agree that pathology services rendered as part of this procedure should not be considered “routine lab services” by anyone.
The coding department’s suggestion, forwarded to me by the hospital’s customer service representative, was that I ask my physician to fax his orders from the procedure to the coding department. Presumably, this would allow them to recode the charges and resubmit them to BCBSIL.
Once again, an opportunity for a customer service department to provide actual customer service was missed.
Gripe number three. The system seems designed so that everyone can say, “it’s not my job, it’s not my fault,” and pass the buck.
I spoke with my physician, explained the situation, and told him the proposed solution. He stated that he understood the problem and would contact the hospital to resolve it. After our initial conversation, he called me back two more times just to let me know he was still working on it, and finally, about two weeks later, to say that it was resolved.
It was a coding error, as everyone knew it would be. It got fixed but the person who fixed it wasn’t a customer service representative, it was a board-certified gastroenterologist with 25-years of practice experience, who had to spend his valuable time resolving a coding error. Gripe number four, in the health care industry, everything will be done in the most expensive way possible.
My story is as common as it is tedious. The needless complexity of health care billing adds tremendously to the already absurdly high cost of health care here in America. Liberals seem to think a government-run plan of some sort is the solution, while Conservatives are entirely focused on thwarting the Liberals.
While I share their distrust of government programs, I don’t see how we can accept the status quo either. The free market has worked its magic in terms of providing quality, but the cost is breaking our backs. It’s not that great health care isn’t worth paying for, it’s that we can see exactly where all the waste is, but no one can seem to root it out. For individual consumers, when even the simplest problem occurs, it takes a task force to solve it.
I have some professional experience in the health benefits field and know a lot more about it than the average person does, so I probably handled the situation as efficiently as it could have been handled. I still had to make several telephone calls, wait for call-backs, sit on hold for extended periods of time, and do other time-consuming tasks. At least two different customer service representatives spent some time on it, as did the physician, and who knows who else. The hospital has a customer service department, a billing department, and a coding department, but they couldn’t fix it without the physician getting involved too. All of that “service” had to be paid for out of the proceeds of that procedure. I wonder how much it would really cost, with all due safeguards, but without all of the “extras,” such as layers of billing complexity, the indigent care “tax,” the cost of excessive liability insurance, and everything else that gets larded into the cost of basic health care.
Everyone agrees that the system is broken but all proposed solutions have so far eluded consensus.
As important as health care is, and as good as the product itself is, the system through which it is delivered is ridiculous. The best symbol of its absurdity is the fact that critical therapeutic information is still communicated from one highly-trained and highly-compensated practitioner to another solely through scribbles on scraps of paper, physically carried from one practitioner to the other by the patient. Only now is the system starting to figure out how to get prescriptions from doctors to pharmacists electronically, and that’s only happening because the Federal Government mandated it as part of the Medicare Part D program.
As usual, politicians are talking about all of the wrong things. It’s not about getting coverage for the uninsured. It’s about reforming, from top to bottom, all of the non-medical parts of a badly broken system so people can afford the care they need.
Happily for all of us, that’s not what this is about. There will be no further mention of my colon in this post.
The procedure is routine. Mine was performed at a hospital here in Chicago, by a gastroenterologist who happens to be the Gastroenterology Section Chief at that hospital. He was recommended by my internist. It was out-patient, in and out in a few hours. Everything was normal. Routine, routine, routine.
My health insurance is with Blue Cross Blue Shield of Illinois (BCBSIL). As I am self-employed, it is an individual policy. I’ve had it for about 20 years, ever since I came to Chicago. It is a Preferred Provider Organization (PPO) plan so I can see any doctor, but I have to use in-network hospitals. There is a deductible and, after that, it pays at least 80 percent of covered charges.
For purposes of this post, that’s enough detail. The coverage is pretty standard, nothing exotic, and it’s not cheap.
My plan does not, as some do, require advance approval for this type of procedure, but I called BCBSIL anyway to make sure everything was covered. They assured me it was.
I’m a pretty healthy guy, but I’ve had enough medical care of various kinds over the years to know the drill with billing and insurance. Everybody gets your insurance information and sends their bills first to the insurance company, which pays the amount it believes it owes. Then the providers come after you for the rest. You expect to receive separate bills from the doctor and hospital, maybe another one for outside lab services, and maybe one or more from other practitioners, such as a pathologist or anesthesiologist.
When the bills start to come, the easiest way to process them is to take the Explanation of Benefits (EOB) reports from the insurance company and match them up with the provider invoices. You should have an EOB for each bill and all of the numbers should agree, including the number you care most about, the amount you owe.
This is my first gripe. When I take my Buick in for repairs, I don’t get separate bills from the mechanic, garage, and parts department. If the work is covered by warranty, I don’t get another envelope full of paperwork about that. I get one bill and it says, “here’s what we did, here’s how much you owe us.” There is no real reason health care can’t be just as straightforward.
But it isn’t.
Although everything should have been routine, in the case of my recent procedure there was a billing problem. BCBSIL disallowed almost $1,500 in lab charges that the EOB labeled “routine lab services.” I immediately called BCBSIL and the representative explained that “routine lab services” are not covered by my policy. I countered that the lab services were not “routine” but were a necessary part of a covered procedure. She agreed that what I described sounded like something which should have been coded as “medical lab” or “surgical pathology,” not “routine lab services,” but at any rate they could not change the coding. That would have to be done by the provider who submitted the charges.
Gripe number two. I maintain that “customer service” in most businesses means “solve the customer’s problem,” but that’s not what it means in the health care business. The ball was back in my court.
So I called the hospital. Their representative agreed that it sounded like a coding error. She conferred with the hospital’s coding department and everyone seemed to agree that pathology services rendered as part of this procedure should not be considered “routine lab services” by anyone.
The coding department’s suggestion, forwarded to me by the hospital’s customer service representative, was that I ask my physician to fax his orders from the procedure to the coding department. Presumably, this would allow them to recode the charges and resubmit them to BCBSIL.
Once again, an opportunity for a customer service department to provide actual customer service was missed.
Gripe number three. The system seems designed so that everyone can say, “it’s not my job, it’s not my fault,” and pass the buck.
I spoke with my physician, explained the situation, and told him the proposed solution. He stated that he understood the problem and would contact the hospital to resolve it. After our initial conversation, he called me back two more times just to let me know he was still working on it, and finally, about two weeks later, to say that it was resolved.
It was a coding error, as everyone knew it would be. It got fixed but the person who fixed it wasn’t a customer service representative, it was a board-certified gastroenterologist with 25-years of practice experience, who had to spend his valuable time resolving a coding error. Gripe number four, in the health care industry, everything will be done in the most expensive way possible.
My story is as common as it is tedious. The needless complexity of health care billing adds tremendously to the already absurdly high cost of health care here in America. Liberals seem to think a government-run plan of some sort is the solution, while Conservatives are entirely focused on thwarting the Liberals.
While I share their distrust of government programs, I don’t see how we can accept the status quo either. The free market has worked its magic in terms of providing quality, but the cost is breaking our backs. It’s not that great health care isn’t worth paying for, it’s that we can see exactly where all the waste is, but no one can seem to root it out. For individual consumers, when even the simplest problem occurs, it takes a task force to solve it.
I have some professional experience in the health benefits field and know a lot more about it than the average person does, so I probably handled the situation as efficiently as it could have been handled. I still had to make several telephone calls, wait for call-backs, sit on hold for extended periods of time, and do other time-consuming tasks. At least two different customer service representatives spent some time on it, as did the physician, and who knows who else. The hospital has a customer service department, a billing department, and a coding department, but they couldn’t fix it without the physician getting involved too. All of that “service” had to be paid for out of the proceeds of that procedure. I wonder how much it would really cost, with all due safeguards, but without all of the “extras,” such as layers of billing complexity, the indigent care “tax,” the cost of excessive liability insurance, and everything else that gets larded into the cost of basic health care.
Everyone agrees that the system is broken but all proposed solutions have so far eluded consensus.
As important as health care is, and as good as the product itself is, the system through which it is delivered is ridiculous. The best symbol of its absurdity is the fact that critical therapeutic information is still communicated from one highly-trained and highly-compensated practitioner to another solely through scribbles on scraps of paper, physically carried from one practitioner to the other by the patient. Only now is the system starting to figure out how to get prescriptions from doctors to pharmacists electronically, and that’s only happening because the Federal Government mandated it as part of the Medicare Part D program.
As usual, politicians are talking about all of the wrong things. It’s not about getting coverage for the uninsured. It’s about reforming, from top to bottom, all of the non-medical parts of a badly broken system so people can afford the care they need.
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