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IN DECEMBER, I fell head first onto the bathroom floor. The doctors agreed I had a mild concussion. These typically heal in four-to-six weeks, but it’s now been five months. In March, I dislocated my left knee cap during an afternoon stroll. I was suddenly unable to put any weight on my left leg.
These two unrelated injuries have required me to see an array of medical professionals and undergo multiple tests, including two magnetic resonance imaging (MRI) scans, one computerized tomography (CT) scan and an x-ray. My physical therapist also suggested getting a second orthopedist’s opinion, suspecting my first one hadn’t bothered to read the MRI technician’s notes. Meanwhile, during a follow-up visit with my primary care physician, he saw no improvement in the symptoms of my concussion. He asked me to see another neurologist for a second opinion.
I called my health insurance company, Oxford Health Plans, a division of UnitedHealthcare. I asked a service representative to email me two lists of specialists who accepted my insurance plan, so I could get the two second opinions.
The lists from Oxford were riddled with errors. They included doctors who had moved, didn’t take my plan or didn’t practice the specified specialties. Often, the phone numbers were simply wrong. Finding no one on the initial lists who accepted my plan, I called Oxford several more times over the next few days, asking again for lists. Mysteriously, each list included completely different doctors. This wasn’t the first time I’d had trouble with information from Oxford. Based on its faulty lists, I must have made 200 calls to doctors’ offices since December—almost all of them duds.
After Oxford wasted my time with its lists, the medical system found a new way to devour my hours. Through the mail came the first of many “explanation of benefits” letters, denying one of my medical claims—and prompting me to call Oxford. A representative informed me that, since my doctor never filed any referrals with Oxford, I would be responsible for paying for all visits to specialists, along with the tests they’d ordered. To add insult to injury, the bills would be for the full amount charged by the specialist, not the discounted fee negotiated by the insurance company. I was in shock. All the bills combined came to roughly $25,000.
I made seven calls that day, over four or five hours, to both Oxford and my primary care physician’s office, asking them to check again and figure out whether there’d been a mistake. Finally, in tears, I talked to a fourth representative at Oxford. He told me I would owe nothing if either party had made a filing mistake.
Two weeks later, after much prodding from me, the secretary at my primary care physician’s office called Oxford to ask what was missing. When I next called her, she sheepishly admitted that they had been filing the paperwork using the wrong identification number. She’s now fixing the referrals.
Fortunately, I’m self-employed, so I can manage my work schedule to deal with all this. But how would anybody with a regular fulltime job cope? Employers should be furious that insurance companies are hurting their employees’ productivity with this nonsense. And insurance companies should be terrified by the ill-will generated by their incompetence. If they don’t want disgruntled Americans to support a total revamping of the health care system, they need to get their house in order—fast.
Lucinda Karter’s previous articles were Bird in the Hand, Pillow Talk and Closet Saver. Follow her on Twitter @LucindaKarter.
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Excellent article. It’s exactly the reason I dread getting old. It’s not so much the inevitable aches, pains and ills; it’s having to engage with our broken health care system, from provider to insurer. I have worked for a large health care system for nearly 20 years and, sadly, can confirm that your experience isn’t rare or unusual. We pay more for health care than any other country on this planet, yet the quality of our health care and the level of access to that care is mediocre at best. We deserve better than what we’re getting.
I am sorry this happened to you. I had an incident a few years back, not nearly as cumbersome as yours. I went to the ER for a kidney stone. I came home. The meds they gave me didn’t work. I went back that night. My first visit got approved by health insurance, so I paid the bill. It was $2,000 (negotiated rate) because I was on a high-deductible plan. Then they rescinded the approval. So then I owed $2,000 on a succeeding bill that I shouldn’t have owed because I met my deductible, but the insurer didn’t think I had because the first ER visit got denied. When calling, I got ping-ponged back and forth. The insurer wouldn’t do anything until the hospital submitted something. The hospital wouldn’t do anything until the insurer submitted something. I had a devil of a time explaining the situation to the broker who was supposed to act on my behalf. No one could understand that I went to the ER twice in the same day for the same thing. Every organization I contacted, I wanted simply to know, “Is anyone working on this?” Finally, it got resolved, but I am not familiar with the system and thus spent way more time than I should have.
After 30 years in healthcare, the best advice I have for anyone is DON’T FALL DOWN.
I can’t tell you how many cases I have seen of people, fairly healthy, who fell, then had a complication, then declined, etc.