w00t w00t booyah

When any insurer (private or Medicare) denies a claim, the next thing that happens is you get two bits of mail per chargeable item: one is the bill from the doc/clinic, the other is the statement of non-coverage from the insurer.

Like how we, an insured family, just got a pile of mail to do with my daughter's eye surgery from a few months ago. Surgery for which we have multiple letters from the insurer agreeing that it was "medically necessary". Turns out that "medically necessary" isn't good enough because we only joined the plan last September and the surgery was in May and it's considered "elective" in the first 12 months of being on the plan, and we started when we did because that's when my husband got his job.

So now unless we can get a letter from a doctor saying the surgery was needed to prevent death and/or permanent injury, we'll be up for more than $4000 in additional bills beyond the copays and deductibles we've already paid (almost $700). Her eye doctor said she'd write a letter saying it was "medically necessary", because it was, her eyes were glued shut with pus every morning and it was causing constant ear infections, but the eye doc won't say "death and/or permanent injury" because it wasn't quite that dire.

So the eye doctor, the surgery centre, and the anesthesiologist are all billing us directly and the insurer has sent us letters that pretty much say, "pbbbblllltttt not our problem go away or we will taunt you a second time."

Our last hope is to try to talk our pediatrician, off on maternity leave, to write the letter for us. After that, we'll have to consult an attorney, which will cost us $200 just for an initial consult, plus the increased bills from the clinics from not paying on time, plus the down-the-road costs for what non-payment will do to our currently stellar credit scores. And based on having contacted attorneys for other matters and knowing what they bill, we'd be out more in attorney expenses than we'd have to pay for the surgery itself.

So actually, it IS a potential horror when these policies come through because the system ALREADY allows for this kind of crap to happen. And it proves, as kyburg says, that despite the outrage coming out of movies like Sicko (which you should see for more lovely examples of this kind of crap), there is little political will to improve health care when the cash is better if you screw over patients.

As long as medicine is a for-profit industry, it will stay bad for patients. Profit motive ALWAYS wins. Nothing will change until it gets so bad that everyone knows directly of someone who has died far too young because of the crap. When things get as bad as they were before the New Deal (ie when kids were coming home minus fingers from working in the factories), then and only then might people be enraged enough to get off their couches and demand real change.


PS I heard about this new Medicare rule the other day on NPR and was thinking, "Oh great, more bills for Medicare patients, glad I'm not one," and then the report mentioned that apparently the Medicare insurers won't be allowed to pass the costs onto patients. Then I laughed and laughed and laughed and laughed. Pah-leeze. It'll be passed on somehow or other in the guise of rising premiums. They'll call it inflation, rising cost of care, whatever they can get away with.