Due to a clerical error at my general practitioner’s office last summer, I got a peek at how fragmented American healthcare can be.
Currently, the US government only funds two kinds of health insurance: Medicare for the elderly and Medicaid for the poor. The rest of us have our healthcare paid for by our employers or pay for it ourselves, via health care exchanges. While the Affordable Care Act (Obamacare) has granted millions of Americans access to insurance, it has done nothing to address the byzantine nature of the medical billing process. Healthcare is a trillion dollar industry and a good chunk of that money comes from administration and data processing. In fact, much of the resistance to sensible reform or the creation of a single-payer system is rooted in the fact that too many people are getting rich from pushing paper.
I’m a contract digital producer. I work with web developers, designers, and product managers on mobile apps, ads, websites and lots of other things that appear on your computer or smartphone screen. It’s fun and challenging work. And even though I’m a contractor, I’m able to purchase decent health, dental, and vision insurance, thanks to Obamacare.
In July 2016, I had a routine physical at my GP’s office here in Los Angeles. The visit itself was unremarkable. I had blood drawn, submitted a urine sample, and chatted about my lifestyle and diet. The doctor was rather aloof, partially due to the recent birth of his first child, and the fact that I’m a 34-year old non-smoker who exercises regularly. Nonetheless, he commended me for prioritizing annual physicals. The visit was completed within thirty minutes and I was on my way to work.
Under normal circumstances, a doctor’s office is supposed to send my fluids to a lab and my insurance information to their billing department. But because the receptionist failed send a copy of my insurance card for processing, I was mistakenly tagged as being uninsured. As a result, I received a deluge of explanations of benefits and bills from five separate entities in three different states:
· The doctor’s office (Los Angeles, CA)
· Biocorp Clinical Lab (Encino, CA)
· Benefits in a Card (Greenville, SC)*
· CWI Benefits (Greenville, SC)*
· American Public Life (Jackson, MS)*
*Thanks to lower labor costs and operators with pleasant speaking voices, a large number of healthcare billing/processing operations are based in the American South.
NOTE: An annual physical is considered a preventative visit under Obamacare. All Health Care Exchange plans are mandated by law cover preventive services “without charging copayment or coinsurance.” That includes cholesterol and blood pressure monitoring, STD tests, diabetes screening, and a whole lot more. All of these services are free of charge, as long they’re “delivered by a doctor or other provider in a patient’s insurance plan network.
TL;DR, a patient visiting an in-network doctor for a routine physical should only have to open their wallet to present their ID and proof of insurance.
My doctor’s office apologized for the mistake and sent a copy of my insurance to their billing office. Then, inexplicably, my insurance company started sending me bills. Frustrated, I decided to do some research. I discovered that my health insurance is managed by two separate entities under the umbrella company Benefits in a Card. The South Carolina-based CWI Benefits is the “Insurance Provider/Carrier responsible for Preventive Care Coverage,” while Jackson, Mississippi’s American Public Life handles “Group Accident, Critical Illness, Hospital Indemnity Insurance, Dental, and Life.” As I pored through the growing mountain of paperwork, I found the disparities between all the bills to be terribly confusing. Why did the statement from the doctor’s office say that I owe $225? Why was the lab asking for $815? Why couldn’t anyone answer my questions?
Attempting to get all the involved parties to communicate was a nightmare. Everybody was clueless and nobody wanted to claim responsibility for the screw up. The receptionist at the doctor’s office was dismissive. Representatives at the lab were evasive when I pressed them about why they were billing a patient, rather than the insurance company. And while the senior manager from American Public Life was charming, she was unhelpful when I asked her “You have proof of my insurance, and you know the law. Why am I being asked to pay for a simple checkup?” It took weeks of phone calls and strongly-worded letters resolve the matter — in March of 2017, more than six months after my appointment.
Sadly, my situation isn’t unique. Millions of Americans can recount similar stories. Had this been a medical emergency, would I have had the time or the energy to fight through this? If I wasn’t as stubborn or resourceful, would I have just cut a check, just to make the bills stop?
Improving American healthcare will not just be about providing coverage. It will require us to take a long, hard look at the industry’s infrastructure. The proposed Republican replacement for Obamacare would not only eliminate coverage for tens of millions of Americans, it would do nothing to reduce healthcare spending, or address the incredibly wasteful private sector bureaucracy. The implementation of a single-payer plan (à la Medicaid for All), would not only guarantee universal coverage, it would reduce paperwork and increase efficiency, ultimately reducing the stress of everybody involved.
Unfortunately, it’s becoming increasing apparent that most members of Congress (regardless of party affiliation) don’t understand how these kinds of complexities burden average citizens. Strong lobbying from the healthcare industry and a lack of basic empathy amongst politicians has resulted in a decades-long refusal to implement real change in how Americans get health insurance. As such, it’s up to us to educate them. I would encourage readers with healthcare stories from hell to write or call their representatives today!
