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.  

REPEALING COMPASSION: TRUTH, JUSTICE, AND THE AMERICAN WAY

I guess if they replace it with RomneyCare,
like in Massachusetts, we won't notice much difference.
That would actually be okay...but why bother?

I wrote the other day about my newly minted access to almost affordable health insurance...thanks to the Affordable Care Act and no thanks to any Republican. This has been a boon to me because my cellular systems had been in rapid deterioration since my COBRA benefits expired. The problem was that no insurance company was going to enroll me for medical coverage because of my preexisting conditions.

Too late, Mitt. I'm already sick.

Now, because of the Pre-Existing Condition Insurance Plan (PCIP) mandated in ObamaCare, I can get rudimentary health coverage (80/20 with a $2,000 deductible) for $376 per month. Republicans are hell bent to repeal ObamaCare as quickly as possible. Mitt Romney says it will be the first thing he does on his first day as Oligarch-in-Chief.

Apparently these bozos think that enabling me to have insurance is somehow un-American. They preferred the system in which the private insurers served as gatekeepers to diagnosis and treatment, and the surest way to save money was to deny coverage to those who most needed it and to deny the claims of those who dared to get sick. Trouble was they didn't pass those savings on to their policy holders. Instead they passed them on to their executives or spent them on lavish self-congratulatory parties in posh resorts. That, so it seems, is the American Way.

Well, is it Fascism or Socialism?
I need to know what kind of un-American
I am for supporting compassion.

A lot of people who ought to know better agree with this bunkum. They have been persuaded to regard me and 30 million other uninsured citizens as a shiftless, lazy mob trying to needlessly burden the federal budget with entitlements it can ill afford. That tens of millions of them are a couple of paychecks away from joining our mob doesn't dissuade them very much from holding us in contempt. This is American Social Justice.

What no one on the other side of this seems to realize is that saving money by denying coverage is a false economy. The money is not actually saved. It's just paid by someone else. 'Who cares,' I can hear them ask? 'As long as the government's not footing the bill, it's not being added to my tax burden.' Well...maybe not your tax burden, but it is likely to be a burden, and no one is immune.

Let's just take me for an instance. I've got insurance now, which has allowed me at least to find out what is wrong with my sinuses. I know I've got a lot of polyps up in my nose. I know they are going to require surgery. I know that they are so severe that they have started to erode the bone tissue of my skull, especially around my eye sockets.

Were it not for the new PCIP insurance, which I pay for by the way, I wouldn't even know that much. Now, just for argument's sake, let's say my condition is even more serious than I know. Let's say that one of these polyps growing inside my head and giving me headaches and preventing me from sleeping through the night—any night—is malignant. Worst case scenario—let's also imagine that I don't have insurance.

Now the Republicans and their Tea Party shot-callers think I should just go quietly. 'Shuffle off and die already. Quit whining about it while we're trying to watch the Real Housewives of New Jersey.'

I actually tend to agree. I'd rather go peaceably. I'm tired of all the anxious suffering.

I know that's not going to happen though. My family is not going to allow it—not even the Republicans among them.

They are going to insist that I get as much treatment as they can afford. They're just like that. They're going to take care of me. I'd take care of them. That's how family works. Here's the fallout though—the hidden cost the Republicans can't see, the dirty little economic fact that puts the lie to any Tea Party Republican idea about fiscal austerity.

Whatever my family spends on my medical care is money that they're not going to spend on new cars, or furniture, or vacations, or any one of hundreds of things they might spend their discretionary income on if they don't have to spend it keeping me alive.

That's just one instance, and I'm just one guy among 30 million who didn't have insurance and won't have it again if the Republicans have their way. So while the rest of you might not be paying for our medical care, you will be paying, in some measure, for the economic fallout of our not having insurance. You were paying for it before. You just didn't know it. This is the American Truth.

Government austerity is a false economy. In fact it's no economy at all.

There was a woman at the doctor's office the other day...same time as me. She needed to commiserate with someone, and since I was the only other person in the waiting room it fell on me. She was having more issues than she had time to deal with because she'd had to take her 42 year-old mentally challenged son out of a day program he was in because our Republican governor had cut the program's funding in half.

Now where do you suppose the money that the governor saved by trimming this program went? It didn't go anywhere really. Ostensibly it reduced the state's deficit, which means that it was money that the state wasn't going to get anyway. Government shouldn't spend money that it doesn't have. Fiscal responsibility.

The problem is that the money is going to be spent anyway—maybe not by the government, but someone, somewhere, is going to end up burdened by the state's savings. It just won't be as equitable a solution as it would have been if the government borrowed the money for cheap and paid it back when the economy turned around and tax revenues went back up.

Here's how it really works. The retarded guy's mom has to now pay to provide her son with the kinds of activities he used to get in the program. I don't pretend to know what they are, but I do know that that woman is now doing what the state used to do. She is less well equipped to do it, and she's had to give up her part time job and a lot of other things including her own medical care to make it happen. So instead of having one burden, day care for the mentally challenged 42 year-old son, the state is now faced with the prospect of having two people on welfare.

Maybe the state isn't actually going to pay for these two burdens where there used to be one, but someone in the state is...one way or another. Maybe it will be when the mother gets carted by ambulance to the hospital for a stress related heart attack. She won't have insurance because she quit her job to take care of her son, who will now have to go into a foster care program or become a homeless vagrant—take your pick.

The hospital will have to raise its rates to cover the cost of her indigent care. The insurance companies that cover those Florida citizens who still have health insurance will raise their premiums to cover the hospital's higher rates. The employers who pay those premiums will not be able to pay bonuses or give raises to their remaining employees because their health insurance costs are too high to allow it. But you know what? At least it's not a tax.

Fact is costs don't go away just because government doesn't pay them. Society still gets left holding the bag. Society just doesn't have to blame the guys who took the benefits away. After all they saved us a bunch of money.

They'll be able to tally it all up and show us charts and whatnot to prove what a marvelous job they did getting government spending under control.

The economy will still be in the tank, people still won't have jobs, and 30 million of us will still be uninsured, but that will all be someone else's fault—probably the shiftless, lazy mob of folks like me who would rather bitch about our lot in life than do anything constructive.

Meanwhile the Republicans can take all the entitlement savings and spend them on tax cuts for their rich friends. The rich friends will make campaign contributions to candidates who are closer to Voldemort than Ronald Reagan, fund scurrilous PAC attack ads, contribute large sums to fancy prep schools where they can incubate more of themselves, and give enough money to the Mormon Church so it can start buying up Vatican treasures. A lot of this is characterized as charitable giving, so, you know, it's comforting at least to know that they are not buying fuel for their yachts either.

More Conversations with Bean: Dogging Healthcare

We've had our greyhound, Bean, for a year now. Every day he grows in wisdom and grace. He is a good dog, eager to please and eager to learn. We have begun to engage one another in conversation with some frequency. He seems to enjoy our little talks, and I find, as his powers of observation grow, so do I. Here is another recent exchange.

BEAN: You remember when you took me to the Vet last week?

ME: Yes. Sorry. It was time for your annual shots.

BEAN: Oh, I don't mind going to the Vet. I mean once they took my nuts, I figured it couldn't get any worse.

ME: Not my fault, Buddy. They did that before I got you.

BEAN: Yeah, I know. Still it seems like a cruel fate. You don't have any idea what's about to happen. They give you a lovely nap, and when you wake up you're carrying an empty sack around. It's embarrassing. I'm mostly over it now, but every once in a while, when I think about it, it gets my back up. You might want to reconsider sleeping in the nude...you know, for your own safety. I'm just sayin'.

ME: Yeah. Okay. Thanks for the warning. We were talking about the Vet.

BEAN: Yeah. What I was wondering is, how come it's so much cheaper for me to go to the Vet than it is for you to go to the Doctor?

ME: I don't know, Bean. I haven't thought about it much.

BEAN: It's not like the Doctor is smarter than the Vet. In fact it's probably the opposite. The Doctor only needs to know how to fix people. The Vet has to know how to fix dogs, cats, hamsters, boa constrictors, guinea hens, cows, horses, giraffes, and hippopotami—just to name a few.

ME: You make a good point.

BEAN: So what's the difference then? Are people more valuable than dogs?

ME: I don't think anyone I know would make an argument like that.

BEAN: Me either. Clearly that would be ludicrous. So what is the difference then?

ME: Well I think it might be the insurance companies. Insurance companies are in charge of most of the healthcare system for people. They decide who gets covered and how much it costs to get covered on the one side, then, on the other side, they determine who gets paid, what services get paid for, and, to a large extent, how much gets paid. They have a significant say in every aspect of the money flow for healthcare in humans, but very little say about healthcare for animals.

BEAN: So you think insurance companies have bid up the cost of healthcare for humans?

ME: I don't know. It's very complicated. If you think about it though, the insurance companies are handling all the money and taking a piece of the action on everything, so the more healthcare costs, they more money they will make. They really don't have a vested interest in keeping medical costs down - only their own costs. They keep their own costs down by limiting coverage to people who are not likely to get sick and then denying the claims of the people they do cover.

BEAN: Sounds to me like you guys need to get the insurance companies out of healthcare.

ME: Maybe so, but that's way easier said than done.

BEAN: Why's that?

ME: Well for one thing, the insurance companies have a lot of money left over from collecting big premiums, limiting coverage, and denying claims. They use that money to make campaign contributions and to pay lobbyists in Washington to make sure that no one in Congress messes with the system. They pay good money, in other words, to keep things as they are.

BEAN: And people put up with this nonsense?

ME: So it would seem.

BEAN: I think someone needs to take this system out on the back porch and chew it up like a rawhide bone.

ME: As usual, you make a lot of sense, my friend.

BEAN: Yeah, and meanwhile you ought to consider just getting your work done at the Vet.