Medical Insurance Insanity and Kos

Kos recently ran into some medical insurance woes - where allegedly Blue Shield told the anesthesiologist’s office that they had paid him, but in reality they didn’t. After 7 months of arguing, they paid $400 out of the $1032 claim.

Personally I hope to never get sick. First, going to the hospital may get you more sick from infections and all sorts of other complications that may happen.

If you do get well, or not, you then have to deal with the insurance/payment aspect. I remember in college, I once had to use three way calling to get the insurance company to confirm with the doctor’s office that a procedure had been done, and to straighten out some codes. Unbelievable.

One of the comments posted on this blog post really resonated with me:

I’ve got an MBA and a PhD in Economics…
… and I cannot reconcile my medical EOBs and bills with the terms of my health plans. Ever.
It used to be simple, transparent, fair. Now it’s insane.

Amen to that. I find the EOBs I get, especially around dental care, to be ridiculously complicated and arcane.

Going through the comments, there are some other interesting thoughts - here’s a few snippets:

This is also just as much the hospital’s fault. They signed a contract with the insurer, then purposely allow all of the individual doctors to be separate corporations so they aren’t subject to the negotiated rates.

Common problem

This is a common and near-fraud problem. I had to have surgery. My in-network doctor referred me to the in-network surgeon who arranged for the surgery in the in-network hospital (easily 10 miles further away from my home than several other hospitals).

Several months later, the $800 bill for the out-of-network anesthesiologist, who was handling all the surgeries for that in-network hospital that day.  Response of insurance company, “you chose to go out of network for this service.”  Sure, first (only) time I ever met the guy, I already had a needle in my arm, had only a surgical gown on, and was minutes away from being taken in for my surgery.  Choice. What choice?

The more stories I see like this,

the more I’m tempted by the Smith & Wesson medical plan…

Based on your experience, I’ll be sure to ask “are you in-network??” as I’m in the throes of labor before allowing anyone to provide any type of medical service. 

This happened to a friend from work. He’s been fighting Aetna over an emergency room visit with the exact same back and forth. It was on a weekend so primary care doctor was closed. Emergencies are supposed to be covered. Insurance drags their feet and eventually pays the “customary rate” to the doctor as Aetna calls it. Doctor wants to get paid and bills my friend for the difference.

Look at the friend office of any doctor or dentist office and see how many full time employees they need just to collect from insurance. Such a colossal waste.

My issue in my 10/2-10/8 emergency admit was multiple demands for copay and deductible as a patient. In the ER [9hrs from start to a acute bed] a demand for my $100 ER copay and a snotty comment “how do you know you will be admitted” … gee maybe being an RN with over 30 years of experience?

On 10/3 someone from the business office came to my patient room with a letter stating they expect me to pay the $721 deductible before discharge. When my room was invaded, I was in severe pain, nurses scrambling and I was on the way to the ICU.

AND then on the day I was going to be discharged, the business office called me in my room saying they expect me to pay the $721 before I leave. HaHa…. no purse, no credit cards, nothing with me…..I was told by the nurses that they are required to wheel patients by the business office before they can be discharged to home…… thankfully none one forced this on me…… I had already raised enough of a stink

There’s plenty more in the thread. Just remember: don’t get sick.