Thursday, September 3, 2009

Health Care Stories: Traverse City, MI

Tim discovers that nobody's harder to insure than a "pregnant" man.

We live in a country with the greatest health care system in the world. Hard to believe? Yeah, I was a little dumbfounded, too, when I heard the news. But I heard it on talk radio, so it must be true. In light of this wonderful revelation, I thought I'd share my own experience with this great system.

It begins in an insurance office. I sit across the desk from an insurance guy as he rattles off a series of questions, rapid-fire. Questions designed to determine whether or not I fall into a high-risk category for medical insurance. So far I'm acing the test. I don't sky dive, work with volatile explosives, perform as a trapeze artist or engage in cliff diving. Hey, I don't even run with scissors.

Then comes the kicker, “Are you expecting a child?” the insurance guy asks. “

“ wife is,” I say, immediately rethinking my all-too-honest answer.

But it's too late, the damage is done. After a lengthy consultation with the insurance guy handbook and even a call into the main office, we only determine what had been all too apparent from the get-go. Even though I'm a man, and although I don't look it or feel it, according to the insurance company, I'm pregnant. And although my wife (who is actually the one having the baby) is fully-covered with another policy from a different insurance company, this pregnancy puts me in a high-risk category. Right up there with chainsaw jugglers and fire eaters. I'm uninsurable.

I have never been pregnant before, so I am expecting the worst. Of course, during my pregnancy I have to take care of my wife, who is also pregnant. We are doing a home birth, and we're working with a certified midwife; but we also need to consult with a regular doctor during the pregnancy. Our doctor of many years has just moved on to the Mayo Clinic, so we were in the market for a new one. My wife has gotten an excellent recommendation for a doctor whose office is right up the street. When I call the office, I am elated to discover that this doctor is accepting new patients. “
“Who is your wife's health care provider?” the receptionist asks.

“Blue Cross,” I say, with authority, invoking the best known name in American health care. “

“I'm sorry, we only accept Priority Health,” the receptionist says.

Luckily, we live here in America where we can choose any doctor we wish (as long as they’re in network), so we choose to choose another one. When we walk up to the reception desk of our new doctor we again get the question, “What's your insurance?””

After my wife presents her card, we are soon told that she has used up all of the two office visits that her $200.00 a month policy provides per year. Then the receptionist asks how we will be paying. “

“Just bill the insurance,” I say, “we'll pay the difference,” knowing that it is impossible to tell what an insurance company will cover until you bill them for it. For example, my wife's office visits are used up, but, if the visit counted as a prenatal, it may be covered.

The receptionist, with apparent pleasure, sternly points down at a sign that says, ALL PAYMENT DUE AT TIME OF APPOINTMENT, written by hand in marker, and underlined.

We need my wife's policy for her pregnancy. If anything should happen and there is a complication, the policy's major medical coverage would come in handy. It gives us peace of mind to know it's there, that is, until I get the bill the informs us that, for a reason unknown to us, the insurance has been canceled.

My wife, groggy-eyed after spending what seems like days on the phone with numerous uncooperative Blue Cross agents (some of whom actually hang up on her) and trying to figure out what the problem is, finally throws her hands up in disgust and gives up.

I pick up the letter that came from Blue Cross and head down to the agency's office in town. After my wife’s experience on the phone, I figure I need to talk to somebody I can reach out and strangle.

Once we get to the bottom of the issue it's no less frustrating. It seems an overzealous sales agent from Blue Cross had recommended to my wife that she get dental insurance with her policy, keep it long enough to get a cleaning, then dump it, without telling her that the dental portion couldn't be canceled without canceling the whole policy. When my wife did cancel her dental policy, over the phone, with one of Blue Cross's telephone service agents, that person again neglected to tell her that by canceling her dental insurance she was, in fact, canceling her whole policy.

We get it straightened out, and I don't have to strangle anybody; but it is not my last trip to the Blue Cross office. During this period my wife needs to have tests done and checkups. That goes with having a baby. Nothing about the way Blue Cross handles this instills confidence. They pay for services late. They often refuse initially to pay for services that should be covered, only to relent and cover these services at a later date. It seems like I get a letter from Blue Cross or a bill from the hospital for services Blue Cross won't pay every day. Almost all services on the statements are abbreviated, so they are impossible to read. The telephone service workers are worse than useless. If one says they will fix a situation, it won't necessarily happen. They have no accountability and you have no idea who you're talking to. A woman in the hospital's billing office finally lets us in on the secret of how to play the game. “

“You never pay the first bill the hospital sends you,” she says, “don't pay the third or fourth either, the longer you wait, the smaller your bill will get.””

It was true. We found that Blue Cross never covered what they should have the first time it was billed. It usually took many more billing cycles than that.

I think I'm finally getting it. When they say America has the greatest health care system in the world, they must be measuring the level of greatness by how much the health care system can screw you over. It's like that old joke about marking the side of your car for each pedestrian you run over. The more people you screw over, the greater you are!

If that's it then we really do have the greatest health care system in the world. But I don't think that screwing people over is the measure for greatness that the anti-health care reform crowd is talking about.

I know what the true measure of greatness is in America, I see it on a regular basis in my job as a bartender at a large golf resort. I often tend bar for large functions sponsored by big pharmaceutical companies or medical insurance providers. These types have open bars that run up tabs of thousands of dollars on a regular basis for functions lasting only one or two hours, and extravagant black-tie parties featuring butler-passed champagne and hors d'oeuvres.

I once bartended a function for a national medical insurance provider that ran up a $50,000 bar bill in one night. The bar crew and I calculated the average consumption to have been one fifth of liquor per person!

No, I think that if America can be said to have the greatest health care system in the world then the measure of greatness is definitely how much money our health care providers and others who make up the system are able to rake in. That, and the fact that they are able to get people like me to pay them through the nose for health care, provide almost nothing in return, and then blame the high prices on malpractice insurance and go blow the money on booze. Why do people like me put up with it? We don't have a choice. Maybe soon we will.

Traverse City, MI


Connecticut Man1 said...

Thought you might find this diary interesting:

Real Canadians Talking Real Health Care

boukman70 said...

Thanks, CM1. I'll check it out.

jadedj said...

I have yet to read one, not even one, health care story in the U.S. that any sane person would consider positive. I can only conclude that those of us who want reform, are the only ones reading.

brimyn said...

Tim, It's not all health plans that provide the pain you experienced ... however, it tends to be the big ones, e.g. Humana, BCBS, etc.

What is missing in the healthcare equation is properly 'incentivized' providers and equally engaged patients with three-fold transparency from health plans for patients: clinical & evidence based information to make health decisions, personalized cost estimates for services, and quality ratings of providers.

full disclosure: I work for a regional health plan with 500,000 members & my passion is providing transparency in healthcare. reach out if you want to chat.

boukman70 said...


You know, I actually invited many conservatives to comment for the project, but I've had very few takers. I don't know if it's my transparent liberalism, or what. I actually wanted as many sides to the debate as possible. What can you do?

Speaking of which, Brimyn, I think you should write something up to further elaborate what you're talking about. I'll be more than happy to post it here. We all need edumacated.

Anonymous said...

I work as a medical receptionist and we hear these types of stories all the time.