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| 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.
