I’m sure all of us have found examples of the evilness of supposedly “non-profit” health insurance companies as they seek to maximize their bottom lines. This complaint is only for $73.24 so it doesn’t qualify for major outrage but does go to illustrate the lengths to which insurance companies go to justify the obscene salaries they pay their corporate officers and then use their “profits” to buy up smaller health providers in their march to secure more.
At age 63, I’ve been plagued by decreasing hearing loss and have gone to an Audiology Clinic run by HealthPartners. I like the audiologist and he takes time to explain my hearing loss and his recommendation to get hearing aids to both enhance my hearing ability as well as hopefully slow down or avoid further deterioration. As a conscientious consumer, I price out similar styles of hearing aids at nearby Costco with the HealthPartners’ model and with the price being competitive, decide to buy the HeathPartners’ ones for $2,600 because of the ability of Dr. Geddes, the Audiologist, to take the time to carefully explain my choices. I’ve had the hearing aids for almost a year and a half and they seem to work well. Dr. Geddes asks me to return annually to re-check my hearing and make sure the hearing aids are working properly.
Meanwhile, my health insurance carrier changes due to my wife’s employer and then retirement and I’m now at the “mercy” [sic] of Blue Cross/Blue Shield who must now share the blame with HealthPartners for my unfolding complaint. Under the Affordable (Health) Care Act, aka ObamaCare, all insurance carriers must provide “preventive care” at no additional co-pay for their customers. Because my new policy has a higher deductible, I want to be sure my return for the annual check-up is covered before I go. So I call both Blue Cross, the insurer, and HealthPartners, the provider, prior to my appointment last July to be sure I won’t have to pay out-of-pocket for this check-up since its purpose is similar to an annual physical. Both parties tell me it “should be covered” – however with the proviso that it will depend on how the visit is “coded”. I make the appointment, stressing that I merely want only this as an annual check-up. The visit goes well, the doctor is his usual helpful self but tells me the “coding” for the visit is done by another department.
It take about a month or so to get the “Explanation of Benefits” statement from Blue Cross (maybe I should add “the ones who put the ‘BS’ into Blue Shield” – but their system is no more or less transparent than the other insurance vultures out there) and notice at the bottom the “amount you owe” is $73.24 after the insurance payment of $63.72. Since it says “THIS IS NOT A BILL” at the top, I hope that I won’t see a bill from the provider. But, alas, the envelope bearing the HealthPartners’ logo with the clear window allowing the customer’s name and address arrives the next month telling me to “Pay This Amount”: $73.24. However, the figures they list to get to this magic total owed by me is different than my “Explanation of Benefits” from BC/BS. The former claims the charges to be $96 with an insurance payments/adjustment of $22.76 while the later tells me the charges are really $179 but the “allowed amount” is only $136.96 so $42.04 becomes the “Provider Responsibility Amount) meaning Blue Cross thinks HealthPartners is over-charging for this “service”. BC/BS tells me it is paying $63.72 but still leaves me with the same $73.24 owed to the provider as my “Deductible Amount”.
So I call HealthPartners to dispute the bill. The “billings” employee I talk to on the phone is quite friendly and hears my complaint. After explaining that I called both BC/BS and HealthPartners before making the appointment, and also telling the doctor that I wished to be seen only for my annual check-up, she told me they will order a “code review” and will contact my insurer so I should not pay the bill until it was reviewed. Finally I received a letter informing me that “HealthPartners Clinics are committed to providing quality customer service and an exceptional patient experience. The coding for your services … has been reviewed and confirmed to be accurate.” It went on to say I could fill out an appeal form if I wished to dispute this decision. The letter was not signed but “HealthPartners Patient Accounting Representative” was helpfully typed after the “Sincerely,”. I filled out the form, hoping for some sanity in this morass.
The letter from Flannery Daley, Operations Manager of HealthPartners Patient Accounting came last week. I must quote the explanation: “This service was covered by your insurance and was applied towards your deductible. Generally speaking, if there is a problem-related diagnosis, a service is not considered preventive. Because you have a diagnosis of hearing loss, the annual check is not considered preventive. Therefore, the $73.24 that Blue Cross Blue Shield has applied towards your deductible for this service will not be waived.”
It would have been helpful if HealthPartners or the doctor would have told me this when I made the appointment! Following this logic, I must pay for my annual eye exam since I wear glasses. I should pay for my annual physical because I am “overweight” – all this despite the clear working of ObamaCare that all insurance companies must provide this preventive care at no additional cost. I can’t say for sure that a Single-Payer plan will cure all these problems but I do know that getting insurance companies out of the mix would greatly enhance the “exceptional patient experience” HealthPartners promised me.
My friends from Iraq just scratch their heads trying to figure out the total confusion and obfuscation of the “Health Care” [sic] system our politics has saddled us with. My new insurance provider starting January 1 doesn’t have HealthPartners Audiology in their “network”. Now, I’ll need to call again before my annual “check-up” this fall.
In all fairness to HealthPartners, this rip-off pales in comparison to my son’s itemized bill from Allina Health for his emergency room visit this fall to Abbott Northwestern Hospital: 4 chewable aspirins (81 mg) listed at $26.40 – a bargain since only 2 acetaminophen tablets were $26.20. But further down a 325 mg aspirin tablet was $26.05. Of course the really important figures are the lines which read “insurance payment: $11,118.86” followed by an “adjustment” listed as “insurance discount: $13,360.19” I guess even HealthPartners (his insurance company this time, not the provider) isn’t willing to pay those prices.
My pharmacist, Tom Sengupta at Schneider Drug in Minneapolis tells me (about health insurance companies): “They’re all evil – but some are worse than others. Try to find the least evil one.” The sign in his front window urges us all to support “Single-payer healthcare for all”.