Monday, August 16, 2010

Healthcare is Broken

Someone needs to call 911 because our healthcare system is definitely in a state of emergency. Although I feel I am somewhat intelligent and I know that healthcare costs have been rising for the last several years, it's not until it has directly affected my family that I have found out just how truly screwed up our healthcare system is. And a quick memo to all of you who think that Obamacare is the answer: it most certainly is not. It is the anti-answer. And yes, I made that word up.

This is a long story that I will try to make short by using bullet points as the highlights:

- Kate is now 10 months old and has had her left eardrum burst three times and her right eardrum burst twice. Needless to say, she has some ear problems and thinks that the cold pink stuff is a yummy snack to accompany all meals. She has had at least eight ear infections that we know of.

- Kate was seen by an otolaryngologist (I did not make that one up) and we were advised to have tubes put in her ears.

- Because of the rising costs of my previous healthcare policy, I have an individual policy through Blue Cross with a high deductible, not astronomical, but not $250. Before taking Kate to the ENT, we hadn't touched that deductible.

- We scheduled the relatively minor procedure for Kate with the doctor and were told we would be going to Phoenix Children's Hospital. It took them a little over a month to fit us in.

- Two days before the procedure, I was called by the pre-registration experts at PCH and told that I would have to PRE-PAY for the procedure because we hadn't met the deductible. Grand total $1,973. Ten minute procedure - two grand. Two days before the procedure. I wouldn't have been all that bothered by this except for what I learned next:

- Uninsured patients have a cash payment option for the EXACT SAME PROCEDURE - $1,020. Upon learning this, I said, "I'll take that option". I was informed it was unavailable for me because I am insured. Let me repeat, I was unable to have the cheaper cash payment option BECAUSE I HAVE INSURANCE. They are required by contract to bill my insurance company. I was floored. I thought it must have been a mistake.

- Anyone who knows me knows that if I think I am right, you are just not going to win an argument with me. I simply will not let it happen. I will talk to whoever it takes, whether it be insurance company management (his name was Vincent), or PCH Registration management (a tool named Linda) the surgical scheduler (Amanda) or the Financial Management Director at PCH (Irma) until I get the right answer.

- For three days, I could not get anybody to give me the answer to this question: "How is it rational that I pay double the cost that an UNINSURED patient pays FOR THE EXACT SAME PROCEDURE????" I must have asked that question 500 times. The answer I got most frequently was: "I don't have a good answer for that. It's just our policy."

- Kate had the procedure, she is a completely different baby now that she can actually hear and Michelle and I are very grateful parents. PCH was an unbelievable facility and the nurses and staff could not have been nicer or more professional.

The point is, I finally did win my argument. Irma, the aforementioned financial director at PCH who was the only professional who I felt was on my side, agreed to bill my insurance and then adjust the amount down to the cash payment option of $1,020. However, I have spent the better part of four days on the phone arguing, name-calling, fighting, complaining and pleading with complete strangers who seem to have more control over my daughter's healthcare than I do. It was the single most frustrating experience that I can remember.

Healthcare is broken. It was broken before Obama took office and it is still broken after Obamacare, probably even more so.

1 comment:

Laura said...

Health Care is broken!!! Next year the cost of our health care rises $300.00 every month and our coverage is less! We are really looking forward to 2011! You are a good writer! How funny that you started listing the names of the people you spoke with on the phone! ....Classic!