Last year health insurance companies reported robust profits while everyone else slumped dreadfully. Eyebrows were raised and practices came under question. How much of an institution founded on partnership with the patient still gives the patient a thought in their meeting rooms?

Many insist quite a bit.

According to a Gallup poll released last year, the majority of Americans are happy with their coverage. Surveys were conducted between 2006-2008. The findings are surprising but they are not out of touch. Just two weeks ago a woman raved to me about her ‘kickass’ coverage that pays without issue.

Yet not all plans are built equal. Every doctor’s office keeps note of the insurer’s who pay for services and the ones who don’t. The stingier companies may blame their frugality on shoddy billing practices, and often they would have a point. Yet a problem remains; when insurer’s and practitioners clash the leftover mess falls onto the patient.

Fruits of tedious L-A-B-O-R

On Monday I was on the phone with my insurance company arguing a single charge of $3,342.10 on a lengthy hospital bill.  After some time—a long time—on hold I was informed the charge was a mistake and would be sent to the adjuster.
This isn’t the first time a claim has had to be ‘adjusted.’ Just as I was about to post this entry Thursday morning, my phone rang. It was  another Blues rep telling me a different claim, from March, had been medically necessary afterall and would be paid in full—-a win no doubt.

But however wonderful these victories are, they are a grind. Each discrepancy means phone calls to the insurer, sometimes drafting a letter, calling the provider and having an extension placed on the bill to avoid collection agencies. Most frustrating, often you still find yourself in collection despite the earlier phone calls. Once in it’s hard to get out. These agencies hassle by mail and phone and don’t have quit in them. An example, a bill from June 2009 was recently adjusted in my favor, still the collection agency persists. The fact that my insurance has acknowledged they made a mistake and paid the bill hasn’t dissuaded the collectors. News travels slowly.

It’s obvious(and disheartening) that the only reason these charges have been “adjusted” is I have time. A lot of it. If my life was dedicated to raising children and working full-time instead of recovering from a bone marrow transplant, I would pay bills immediately to avoid all the drudgery.

Part of the ‘I(nsurance)’ Team

The ‘Member’s Benefits’ booklet welcomes the insured to Empire Blue Cross Blue Shield. The first page is a letter that assures they will work to keep you healthy and closes with a bang, “we look forward to serving you.”
All service isn’t exemplary.The day I entered the hospital to start my transplant regimen my insurer called to say the transplant would not be covered. The misunderstanding was eventually handled, but stress was not avoided.

It’s hard to just poll people outright on their health insurance because the variables are endless. Some people can afford massive premiums, some people are a part of unions who bargain hard for gold-plated plans and some(or more than some) are healthy enough to remain removed from the industry. But there are those like me, who get really sick and take more from insurance than they ever put in. We are the expensive ones, the dead weight that leaves CEOs shaking their heads. For better or much worse, we are a member of the team though—and have the letter to prove it.

Post to Twitter Tweet This Post