Tuesday, December 2, 2008

The insurance quagmire -- enough to make your sick!

Today, was one long day of digging into the insurance nightmare. I am boggled how medical billers (doctors, hospitals, any medical provider etc) charge the amount they do for services, or sometimes they don't charge for services. Sometimes insurance pays far more than I think they should, and other times, they have these bizzare rules that make, what seems like a legitimate charge ineligible. It is completely random. I have over 5" of Explanation of Benefits (EOBs, in industry speak) for this year. That is over 2 reams of 500 sheets of paper. It is insane. What is more insane is that I, as the patient, am stuck in the uncomfortable middle. There is no transparency in the medical billing/insurance system. It is totally fucked up! I as a consumer have almost no rights, which seems completely wrong. All I can go by is my hutzpah. Sometimes that only goes so far. There are times I simply pay because I am too exhausted to fight.

There are so many different types of billing schedules for every variety of insurance plans offered within a single company (i.e. PPO, HMO, traditional indemnity, other flavors of indemnity, etc...) and then add across all companies. It is insane, and a huge time synch to fight for your rights. It is bad enough to deal with a series of cascading health events. Then, add the stress of insurance. No wondering why our country is in the hole with medical care. I really hope with the new administration there will be leverage to improve (what I really mean is overhaul) the healthcare system in our country. I hope that some healthcare 2.0 initiatives take on insurance issues, including patient advocacy.

1 comment:

Katrina said...

Hi Alex,

I could not agree with you more. There is something incredibly aggravating about EOBs and the way information is presented to patients and consumers. Its also frustrating that very few resources that exist to guide patients through all of the terminology, processes of appeals, claims denials, and reconciliation of bills payments and EOBs.

I work at a company called change:healthcare, and our whole concept was born out of my boss' frustration with the healthcare system. Transparency is what we are all about (as well as helping patients understand the confusing system).

I would love to send you a copy of our book "My Healthcare Is Killing Me: A survival guide for the American healthcare consumer." Even though you are probably an expert now yourself, I think the book has some valuable information and I want to reassure you that our Health 2.0 company is attempting to bring valuable information about down to the patient level.

Best!

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