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Aaron N. Tubbs

Dragon chaser.

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Why I Hate The Healthcare System, Part 2

It’s really more like part 30, but I don’t complain about the insurance system in America as much as I should.

Here’s the story. Back on November 1, 2005, I had a CT scan. At that point, I provided my insurance information (photocopy of the insurance card and all that jazz).

Late December, I get a bill from the radiology unit for about a grand. At the bottom of the form is a note saying “please provide updated insurance information.” I call, and ask what’s going on. Apparently, they’ve lost my insurance information. Fine. I fax them my insurance card again, and confirm they receive it.

Mid January, I get another bill from the radiology unit, exact same message, verbatim. Well, there’s one difference. Now my bill is delinquent, and is going to collection soon.

I call, and am a little livid. Some bills I didn’t know about going into collection caused a lot of credit trouble for me back when I was in college. All this time while the radiology folks have been sitting on their hands, my insurance company has issued a new insurance card (on January 1st, I received it a week later) with a new ID that does not contain my social security number. Being a charming bunch, they have also invalidated my old number. Now, apparently the reason it takes two months for the radiology folks to bill is they first have to send the bill to an accounting department elsewhere (in New Jersey, of all places).

So, I provide them my updated insurance card information, and they submit to insurance.

So, Friday, I receive an explanation of benefits form (according to the insurance company, they first processed the claim on 2/1 … there’s an inherrent two-week buffering delay in any sort of progress for insurance). It looks like this (condensed)

PROVIDER/SERVICE   STATUS CODE   ...   PATIENT BALANCE   MESSAGE CODE
----------------   -----------   ---   ---------------   ------------
DIAG. SCAN         A             ...   0                 A141, A932
RADIOLOGY          R             ...   300               B697

STATUS CODES:
A - APPROVED, AJ - ADJUSTMENT, R - REJECTED, V - VOID
MESSAGE CODES:
A141 PAYMENT HAS BEEN MADE DIRECTLY TO PROVIDER ON YOUR BEHALF
A932 AMOUNT COVERED LIMITED TO WHAT YOUR PLAN'S ALLOWANCE IS FOR PROCEDURE
B697 SERVICES RENDERED BY THIS PROVIDER ARE NOT PAYABLE

Now, despite these “explanations” this makes no sense to me. I had a CT scan. A radiologist looked at the CT scan and provided a report to my doctor. One isn’t particularly useful without the other, so this all strikes me as a little odd.

So, I try to call Anthem Blue Cross/Blue Shield on their direct service line in Connecticut. Well, first I’m greeted with a menu asking if I’m from Yale press 1, Yale Medical press 2, SNET press 4, … 5 more options … for all other queries, press 3.

If you’re calling about blah blah blah … direct line my ass.

Anyhow, eventually the IVR lets me navigate to acquiring claim information, as there is no “what is going on with my claim?” menu option. I have to first enter my member ID, which contains alphanumeric characters, so I have to type something like 00048887123(*43#)15467# on my keypad, the crap in the middle required to decode the alpha character.

Then I have to provide my date of birth.

Then I have to provide my claim service date.

Then I need to provide my claim number.

Now I’m informed it’s gathering information. I’m informed of this six more times.

Then it tells me what’s on my claim form. Neat. Took me ten minutes to get to this point.

Now I only have the option to query another claim. I hit 0 out of desperation, and it informs me that due to the nature of my query, I will be connected to an operator.

Thank god.

I’ll spare you the pleasantries. Suffice to say, it required me to reiterate my identification number, date of birth, mailing address, phone number, claim date, claim number, and all that jazz again. I am still not sure why IVR systems gather information they can’t remember.

I talked with a pleasant operator (it’s early, but the small things make a difference at this point), who takes a few minutes to pull up my claim and start looking at it. “Apparently that provider has two provider identifier codes, and they submitted with the wrong one. If they resubmit with the other provider ID, it should be fine. Have they called you about this claim yet?”

Now, why would they call me? Obviously this is something they need to sort out themselves.

A lot of conversation ensues from this point, and I express my frustration that this claim form tells me nothing, and only angers me. I know this lady can’t change any of this (and I tell her as much, and apologize in advance), but she does her best to explain that this claim explanation form is sent to me in attempt to make things more clear, rather than just keeping me out of the loop for another two months. I’m not sure whether bad information is better than no information, but eventually I grow tired of the conversation. I’ll spare you the details.

Here’s the crux of the problem. Both the radiology accounting unit and the insurance company knows what’s going on, and knows the information that needs to be traded back and forth in order for me to not have any financial obligation. Unfortunately, until at least two more snail mail transactions take place, this situation will not be resolved, and that’s if everything goes perfectly. Based on past experience, the chance of this happening is a number very near zero. Thus, it’s going to surely take another couple of phone calls for me to facilitate things before I actually am clear of this charge. I expect this to happen sometime before November of this year.

Now, let me tell you that this is all just because they are a provider. If they weren’t a provider and they hadn’t signed up, “well, you would just be out of luck right now, I’m afraid.”