Why Is It My Job to Sort Out Billing and Insurance Issues?

[Anonymous]

You have to understand health insurance is a bureaucracy, and rule number 1 of a bureaucracy is NOT to help the people it ostensibly serves. Helping people in theory is still a rule but it's not even in the top 10 rules. Rule 1 is to protect the bureaucracy at all costs.

That is why it's so difficult to even to speak to anyone in the first place. Why all the names are buried behind the generic "Shanta B" or "Tierra G" with no last names. That's why no email addresses are given, only phone numbers to answering machines. That's why the paperwork is so vague and if you write a grievance letter (which must be mailed, never emailed or uploaded online) to a distant office, they will never answer any of your reasonable questions but some kind of autobot generic response that clarifies nothing and invites you to call this number, which once again is an answering machine that no one answers. That's why six different people will tell you the exact same thing when you're trying to find a different answer. That's why it takes six weeks or a few months to get anywhere.

It's not 1990 any more. Everyone in healthcare is first and foremost a bureaucrat. Their occupation, whether doctor or administrative, is secondary. Once you understand this, then you understand why they behave the way they do. I know I am a number to them, I know I am instantly forgotten the next second. As a result I no longer attempt to be nice or considerate whenever I have to deal with any healthcare situation (thankfully not very often). I'm sure I'm rude and brusque, but that is exactly how I'm treated by them behind that fake facade of niceness.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:take 'em to court OP. It could be a groundbreaking case that gets media attention, picks up steam, and gets real reform and results.

I used to do this for a living. No one cares. Media are not covering it. And the reason OP has to do it is because she has elected to pay her bill with insurance instead of cash. Either way it’s on her to make sure it gets paid.

Honestly though the only issue I’ve ever had with my carrier in more than 20 years was whether certain care was reasonable and necessary.

The New York Times has done several articles on patients coping with catastrophically large surprise medical bills, patient's inability to get billing info from hospitals, patients mistakenly getting out of network treatment that costs them a fortune rather than the in-network treatment they thought they were getting. There are many media articles about insurance billing horror stories.

But nothing changes, and we pay the most in the world yet have unexpectedly limited health outcomes as a population given the $$$$$ we pay because Republicans scream "socialized medicine" every time anyone tries to change these practices in the favor of patients.

The healthcare industry are much bigger donors to the Dems than the GOP. I think both Bernie and Elizabeth Warren are among the largest beneficiaries of donations from the industry.

Things got a whole lot more complicated and expensive when Obamacare was launched....

[Anonymous]

This is why so many people cheered Luigi.

[Anonymous]

Anonymous wrote:a whole book was written about this deny, delay, etc.

its the business process of all the insurance companies.

they count on you to give up or stay in network which saves them money

I keep a spreadsheet; see the doctors who I want; get the superbly and submit ASAP. There have been many hiccups (I report them to the healthcare ombudsman who sends a letter that is required by law to be responded to). For the routine weekly visits, I get reimbursed in two weeks.

yup. reading this while on hold with united healthcare. i am fortunate to have a PPO and be able to be reimbursed for out of network, but they sure do NOT make it easy. and its frustrating how many doctors in this area do not accept insurance.

[Anonymous]

I have been stunned by the lack of consumer protections from insurance companies. They can just deny claims improperly and as long as they eventually approve things after a big fight, they face no consequences. They have every incentive to make things exceedingly difficult for providers, patients and their families. We thankfully have a plan that reimburses for providers that don't accept insurance. I truly cannot blame them for not accepting insurance. I'd rather they focus their energies on providing services instead of dealing with paperwork and their rates are perfectly reasonable. I actually have less sympathy for providers that take insurance and then charge people paying OOP 2-3x times the amount they take from insurance. And I have absolutely dealt with providers that are at fault for insurance issues. Like billing me because "insurance didn't pay enough" when in fact insurance paid their contracted rate, and it takes a minimum of 30 minutes of my time to convince them they screwed up. Or another provider that sent the claim to the wrong address, but I have to call them 3 times to convince them that (1) my insurance is in effect and (2) they need to resubmit the claim. It is exhausting.

[Anonymous]

Anonymous wrote:You have to understand health insurance is a bureaucracy, and rule number 1 of a bureaucracy is NOT to help the people it ostensibly serves. Helping people in theory is still a rule but it's not even in the top 10 rules. Rule 1 is to protect the bureaucracy at all costs.

That is why it's so difficult to even to speak to anyone in the first place. Why all the names are buried behind the generic "Shanta B" or "Tierra G" with no last names. That's why no email addresses are given, only phone numbers to answering machines. That's why the paperwork is so vague and if you write a grievance letter (which must be mailed, never emailed or uploaded online) to a distant office, they will never answer any of your reasonable questions but some kind of autobot generic response that clarifies nothing and invites you to call this number, which once again is an answering machine that no one answers. That's why six different people will tell you the exact same thing when you're trying to find a different answer. That's why it takes six weeks or a few months to get anywhere.

It's not 1990 any more. Everyone in healthcare is first and foremost a bureaucrat. Their occupation, whether doctor or administrative, is secondary. Once you understand this, then you understand why they behave the way they do. I know I am a number to them, I know I am instantly forgotten the next second. As a result I no longer attempt to be nice or considerate whenever I have to deal with any healthcare situation (thankfully not very often). I'm sure I'm rude and brusque, but that is exactly how I'm treated by them behind that fake facade of niceness.

+1, and for doctors too. Beyond the ridiculous prior authorization hoops (which have been easy lawsuits the few times they’ve been pursued since they clearly cause actual medical harm), I’m a doctor in private practice and take several insurances but not Aetna. I considered adding Aetna and tried to find out how much they would pay me for specific services, because I am obviously not going to sign a contract with them without that information. There is no option to do this in writing. The phone number they give just puts you in a hellish loop of recorded messages with no option to speak with a person. Calling other Aetna numbers just results in being turfed to those recordings, like a satirical Soviet novel. Per their website, the only way to find out what they pay is to do the credentialing process with them (hours of paperwork and effort, getting recommendation letters, official copies of licenses, etc) BEFORE they will tell you what they pay. No thanks, so there’s another doctor not accepting Aetna. There is no other type of business that operates like this. Like if you could only see the prices of things at the grocery store when you are at the checkout counter, or even worse for patients, after you have already bought them. It doesn’t have to be like that and is another example of why health care and for-profit corporations are not ever a good combination. Medicare has set rates that are the same for all doctors in a particular zip code and are transparent and are published on the internet. i have worked in two other countries, both with socialized medicine, and it’s amazing how much more money is available for things like preventative care when you cut out all of the layers of profit-taking middlemen, and how much less opportunity cost there is for patients and doctors in not having to deal with them.

[Anonymous]

Anonymous wrote:I'm getting increasingly frustrated with how much time I spend on the phone dealing with medical billing and insurance overages. I have a full-time job, and every time there's an error or a dispute, it somehow falls on me to resolve it.

I end up chasing down doctors’ offices, calling insurance reps, deciphering billing codes, and making sure everything is accurate just so I’m not overcharged. Meanwhile, the doctor gets paid, the insurance company takes their premium, and I’m stuck doing unpaid administrative work to keep it all in check.

I charge $300 an hour in my professional work. Maybe I should start invoicing these companies for the hours I spend fixing their mistakes. Why is my time treated like it has no value just because I’m the patient?

None of this feels like it should be my responsibility, and yet if I don’t deal with it, I get stuck with the bill. Can anyone explain why this burden is now on us? Because I’m tired of doing their jobs for free.

You and the insurance company have a contractual agreement...their issues are not the responsibility of the doctors office.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm getting increasingly frustrated with how much time I spend on the phone dealing with medical billing and insurance overages. I have a full-time job, and every time there's an error or a dispute, it somehow falls on me to resolve it.

I end up chasing down doctors’ offices, calling insurance reps, deciphering billing codes, and making sure everything is accurate just so I’m not overcharged. Meanwhile, the doctor gets paid, the insurance company takes their premium, and I’m stuck doing unpaid administrative work to keep it all in check.

I charge $300 an hour in my professional work. Maybe I should start invoicing these companies for the hours I spend fixing their mistakes. Why is my time treated like it has no value just because I’m the patient?

None of this feels like it should be my responsibility, and yet if I don’t deal with it, I get stuck with the bill. Can anyone explain why this burden is now on us? Because I’m tired of doing their jobs for free.

You and the insurance company have a contractual agreement...their issues are not the responsibility of the doctors office.

In order to take insurance, doctors enter agreements with insurance companies and become responsible for filing claims. The provider agrees to the rate that the insurance company pays. That is the entire point of taking insurance.