Testimonial for U.S. Health Care System
he still stands
Posts: 2,835
<rant>
I already posted this in AET but thought first hand knowledge of the "Sicko" phenomenon might spark some conversation about how undeniably FUCKED the US health care system is.....
So I get a bill from collections the other day in regards to a hospital visit in January. I had previously taken care of it, or so I thought, when I called BLUE CROSS BLUE SHIELD and they told me the claim was taken care of, I owed NOTHING.
Now I call them again, and I get a completely different story.
"This particular department of the hospital (radiology) is not within your network, so it isn't covered."
me - "So I should ask each person, whether it be a doctor, nurse, radiologist, etc within the hospital if they are in my network before they do anything? And I should visit a different hospital for each department that is within my network?
her - "Unfortunately that is the way it works."
ARE YOU FUCKING KIDDING ME!!!!!!!!!!!!!!!! SOME DEPARTMENTS OF THE HOSPITAL ARE WITHIN NETWORK AND SOME AREN'T???? AND BLUE CROSS'S WEBSITE SAID THE HOSPITAL WAS IN NETWORK, WITH NO STIPULATION ABOUT SEPARATE DEPARTMENTS!!!!!!!!!! NOW I OWE FUCKING $665, AND THE ONE FUCKING VISIT FOR MY WIFE (A SIMPLE KIDNEY INFECTION) IS GOING TO COST ME ABOUT $1000!!!!!!!!!!!!!!!! AND I PAY $164 / MONTH FOR THIS GODDAMN HEALTH INSURANCE!!!!!!!!!!!!!!!
FUCK ME IN THE BRAIN. DON'T USE BLUE CROSS BLUE SHIELD.
</rant>
I already posted this in AET but thought first hand knowledge of the "Sicko" phenomenon might spark some conversation about how undeniably FUCKED the US health care system is.....
So I get a bill from collections the other day in regards to a hospital visit in January. I had previously taken care of it, or so I thought, when I called BLUE CROSS BLUE SHIELD and they told me the claim was taken care of, I owed NOTHING.
Now I call them again, and I get a completely different story.
"This particular department of the hospital (radiology) is not within your network, so it isn't covered."
me - "So I should ask each person, whether it be a doctor, nurse, radiologist, etc within the hospital if they are in my network before they do anything? And I should visit a different hospital for each department that is within my network?
her - "Unfortunately that is the way it works."
ARE YOU FUCKING KIDDING ME!!!!!!!!!!!!!!!! SOME DEPARTMENTS OF THE HOSPITAL ARE WITHIN NETWORK AND SOME AREN'T???? AND BLUE CROSS'S WEBSITE SAID THE HOSPITAL WAS IN NETWORK, WITH NO STIPULATION ABOUT SEPARATE DEPARTMENTS!!!!!!!!!! NOW I OWE FUCKING $665, AND THE ONE FUCKING VISIT FOR MY WIFE (A SIMPLE KIDNEY INFECTION) IS GOING TO COST ME ABOUT $1000!!!!!!!!!!!!!!!! AND I PAY $164 / MONTH FOR THIS GODDAMN HEALTH INSURANCE!!!!!!!!!!!!!!!
FUCK ME IN THE BRAIN. DON'T USE BLUE CROSS BLUE SHIELD.
</rant>
Everything not forbidden is compulsory and eveything not compulsory is forbidden. You are free... free to do what the government says you can do.
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http://www.myspace.com/illuminatta
Rhinocerous Surprise '08!!!
IT IS!!!
DOUBLE FARTS!!!
a couple of years ago my primary physician sent me to see a specialist. Later, I received a bill from a specialist, requesting I pay the full bill as my insurance did not cover the service even though I was sent to this specialist by my primary...I even asked the specialists office if "they bill my insurance"...and was told "yes"...
apparently my question should have been "are you in my network"...?
I raised hell with my doctor's office for sending me to an out-of-network provider...they worked with the specialist and the charge was written off...
Also, everyone should be aware of who reviews x-rays and bloodwork....often doctors send this sort of work out to be read...always ask you doctor if those who review things outside of their office are in your network...
sorry you had to go through this...
thanks.
It's just so frustrating. Its obvious to me that health care providers aren't too worried about having every "department" within a hospital be "within the network." Its a good way to externalize their costs and they get away with it.
This is STEALING in its most primitive definition. 200 years ago someone would lose their head if they fucked me over like this, and society would agree that I had the right to do so. Now the corporations have all the power, and protection from our government, and there is nothing I can do except bend over, take it in the ass (without lube), and pay the bill.
God Bless America.
Do you have a good HR person at your job? I had an issue a couple of years ago, and my HR manager helped me go at the insurance company, and between her and my primary doctor, their combined "clout" got the specialist covered.
was like a picture
of a sunny day
“We can complain because rose bushes have thorns, or rejoice because thorn bushes have roses.”
― Abraham Lincoln
thats a good idea. I think I'll send an email to my HR rep and see what she can do... with my past experience it will be nothing... but Hey I can at least try.
I work for a large hospital system and deal with a particular population of patients. Unfortunately, it has become necessary for me personally to call their insurance companies to confirm their benefits and make sure everything is billed properly so they don't get stuck with big bills. It's an impossible process. First, you get 20 minutes worth of an automated system that won't let you through to an actual person (BCBS is particularly bad about this). Then you spend 20 more minutes on hold. Then you ask your question and get transferred several times.
Once you do get the correct person, there are so many aspects of health insurance that it's nearly impossible to ask all the right questions in all the right ways. I used to just ask the obvious question: "Is ___ procedure covered for this patient?" They would just say yes and I would relay that information to the patient and we would think all was good. But turns out it's not that simple. It all depends on exactly which billing code you use.
Then you learn to ask whether we (the provider) are in-network. (We don't know for sure any more than the patient does. Just because BCBS said we were last week, doesn't mean we are this week for this particular patient's plan.) They may say yes or no or whatever, but it turns out it's all a matter of exactly which provider # is used. And then they sometimes try to tell you that even though your hospital is in-network, provider ___ isn't in-network or that they don't even work for your hospital (even though they do).
Then, if they say ___ procedure is covered and ___ provider is in-network for this patient, turns out there are many other things to consider. Maybe it's all "covered" but the patient has a $5000 un-met deductible - so that means they'll get the whole bill up to $5000. Or maybe it's covered, you're in-network, the deductible has all been met, but the patient has 20% co-insurance - meaning they'll still have to pay 20% of the total bill. Or it's covered, you're in-network, the deductible has all been met, there's not coinsurance, but turns out one part (or all) of your appointment required a prior authorization. Or there could be any number of other technicalities.
Now, let's say you've asked all the right questions and the person at the insurance company tells you it's all good (or bad). You could call again the next day and talk to a different person at the same company and they might tell you something entirely different.
But that doesn't matter anyway since "confirmation of benefits is not a guarantee of payment." And also since there are plenty of bills that are erroneously denied.
It's impossible - even for the providers, much less for the patients. Not to mention the amount of money my employer has to pay me to spend hours of my time dealing with insurance companies when I could be doing more productive things. But they pay much, much more to employ people whose sole job is to figure out what is covered, obtain prior authorizations, make sure the billing is exactly the way the insurance company wants it, and then fight with them when they deny bills they should have paid. Providers must spend all this money just to be able to interact with the insurance companies and then the companies don't even reimburse us at full price anyway!
The most important things to remember are:
1. Ask the doctor's office what's covered, etc., but also call the insurance company yourself and try to understand all the subtle details of how it works and how you might get screwed.
2. This is a really fucked-up system and it needs to be changed.
second that, now I know the questions to ask in order to 'minimize' the chances of this happening again.
It's wrong to expect somebody seeking medical care to have to ask if something is being done in their network for every damn thing.
If I have made sure the doctor is in my network, that should be enough.
I had to pay for labs and x-rays because of this bullshit loophole.
I have since switched to an HMO (Group Health) where most everything is done in house and they do everything (like pre-authorizations) for me.
It has been a HUGE relief.
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"We've laid the groundwork. It's like planting the seeds. And next year, it's spring." - Nader
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Prepare for tending to your garden, America.
we don't have a health care system in the United States..
we have a health care industry.