Tuesday, May 21, 2013

My Doctor is Holding My Money – Another Heartbreaking Reality of U.S. Healthcare

This might pinch a little.

My oncologist owes me $1,500 and change. Her office insisted that I prepay my first two chemo infusions because my insurance company told them I had not satisfied my deductible. I knew this would become a problem for me, but I had cancer. What was I going to do, delay treatment until all the insurance foibles resolved themselves? Hell no. I paid up and took my medicine.
Cancer is expensive as hell. The total billings for my disease are approaching half a million dollars. Without insurance I'd be dead already. I wouldn't even have insurance were it not for the Affordable Care Act, better known as ObamaCare. I was able to get into the Pre-existing Condition Insurance Plan, or PCIP. My pre-existing conditions related to my hypertension. They had nothing to do with my cancer, but still no one wanted to give me insurance when I was already infirm. Too big a risk for them. Better I should just die and not burden the system that pays the insurance execs fat bonuses and annual sales meetings in the Caribbean.
PCIP is not free, but it is reasonable. My policy premiums were $376 per month for the first six months and $436 per month for the next six months. After that I qualify for Medicare, so PCIP coverage automatically terminates. I will have had it for exactly one year, but since the plan year is a calendar year, my coverage spans two plan years. This cost me an extra $6,250 dollars in out-of-pocket medical expenses because the out-of-pocket maximum for deductibles and co-pays reset on January 1. So be it. I still got pretty good coverage, and was only personally responsible for a little over $10,000 of the total cost of my care.
A lot of people with good insurance pay a lot more to deal with cancer. Cancer causes a lot of bankruptcies—even among people with insurance. This is why I am a big believer in universal healthcare. Sure it's costly, but it's not as costly as the system we've got now.
I'm a big fan of ObamaCare too. You can't get me to say anything bad about it. It may be flawed, but it saved my life. If that's not good enough for you, too bad.
So back to the oncologist. My guess is she doesn't even know that she owes me money. She deals with the cancer and she pays an administrative group to deal with the money. The administrative group's function is to make sure the doctors don't miss out on any money. I don't really have a problem with this until they decide to over-reach. My doctors work hard. They are smart. They are doing good work. They deserve to be compensated. That doesn't mean however that I am happy to let them earn interest on my money while I struggle to pay my bills. That's not fair.
They all drive German cars and live in big houses. They take nice vacations in exotic locations, and they maximize their contributions to their retirement plans.
I don't have any of that. I don't even have a job. So when the doctors' administrators decide to hold on to my money to make sure that they milk every available penny out of my insurance company, they are doing me an injustice. They are creating a hardship for me that I can't afford.
When my doctor's office made me pay in advance, they expected that payment to cover the deductible and the co-pay. They didn't want to have to come after me for the shortfall later. I understand that...understood it at the time. The insurance company however allocated the whole deductible and all the co-pays up to my maximum annual out-of-pocket cost to another doctor. So when they paid the oncologist, they paid her 100% of the contracted allowable for each claim. They didn't deduct anything, so the amount I prepaid was due back to me. I need it to pay the other doctor. Hell I need it to pay a lot of things. I do not need it to be sitting in my oncologist's bank.
Another thing to consider is that no one makes it easy to figure out where you are between your insurance company and your medical providers. My oncologist group doesn't even send out statements. I spent a week going through all my bills and benefits notices and matching everything up. I'm a degreed accountant, a former CPA. It was hard even for me, but I was able with effort to figure out that there was a credit balance in my accounts with several of my doctors. They weren't about to tell me about it. Apparently they expected me to figure that part out for myself and come ask them for my money back. What chance does some poor widow have, grieving for her dead husband and hard pressed by her doctors and hospitals, to figure out that her doctors are trying to fleece her in her hour of need?

I am not a fan of this. I shouldn't have to fight with my doctor's office to get my money back. I shouldn't even really have to ask them for it. They should just give it back. They don't though. Most of them will never tell you you've overpaid. They'll wait for you to figure it out. If you don't, well more money to put diesel in the yacht. Seems to me that profanity is the only appropriate response.
Even more so now that I have caught them out and asked for a refund. They still don't want to give me my money. They are going to make me wait until all their outstanding claims have been addressed by my insurance company. They are doing this even thought they know that my insurance company is reimbursing them at 100% for the remainder of the plan year. To me this is an unimaginably bogus state of affairs.  

1 comment:

  1. Greed, Dishonesty. BS. These are the negatives. I'm glad you got good care, coverage with pre-existing conditions and you're better. The positives. They definetly outweigh the negatives but....the negatives are greed, dishonesty and BS and unnecessary. Why can't the experience be totally fair. Is that too much to ask? Appears so. That's life.


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