Monday, July 28, 2014

What A Bargain!





I just got a bill today for a pair of crutches and a compression boot from when I tore my Achilles tendon. Not an unusual occurrence, as far as these types of things go, except for a few little nuggets of joy.

First, this happened in December of 2012, a couple of days before Christmas.

Second, the first time I got the bill, I was told by UMR, the insurance company, that it was a mistake and that they would take care of it. This was in June of 2013.

Today I called them again to let them know that something had not gone as planned. I was told that not only did they not take care of it, they would not take care of it because my ex-wife's company (from whom I was getting the insurance at the time) was no longer a client.

And it gets better.

I tried, as calmly as possible, to explain that this was an error on their part, and that there was no statute of limitations on this. It was very patiently explained to me that I had in-network and out-of-network benefits, and even though the emergency room was in-network, the medical supply company that provided these things to the hospital in the first place was out-of-network, and I should have researched this before getting care.

I pointed out that, at the time, it was 20 degrees and after midnight, and further that I had torn my Achilles tendon and literally had to crawl across the parking lot from the car to the ER, and that I didn't think this was a reasonable expectation for me to engage in comparison shopping at that particular juncture.

She apologized for the confusion, and asked if there was anything else she could help me with. As if she had helped at all in the first place.

This is but one example of this thinking. According to UMR, the hospital was in-network. However, the company that provided the crutches and compression boot to the hospital was out-of-network, and if I wanted to get these things paid in-network I should have either gone to a different hospital or specified a different medical supply house. In this case, instead of the insurance company taking responsibility for "it's an emergency, it's late at night on a weekend, there's really no opportunity to check these things out thoroughly under these circumstances", it turns out that, before I hauled myself to the ER in the middle of the night, unable to walk and in an unbelievable amount of pain, I should have made a few calls to area hospitals to see who provides their medical supplies, so that I could intelligently purchase my health care on the open market, as God intended.

On another instance, my son sprouted an angry red rash over most of his body. It came on rather quickly, and it was about 8:30 on a Sunday morning, and he was experiencing what medical professionals call "discomfort", and what normal people call "itchy and painful and making a seven year old cry". So, like any concerned parent, I took him to the emergency room. The docs looked at him, said it was obviously an allergic reaction to something but darned if they know what it is, took a couple of blood samples and sent us home with instructions to rub cortisone cream on the affected areas and let them know if things didn't improve in a couple of days (they did, thankfully).

UMR, in their infinite wisdom, said that diagnosis codes indicated that it wasn't a true emergency, and therefore they would not pay the claim because, under the terms of the policy, non-emergencies were to be taken to walk-in clinics such as UrgentCare instead of the ER. When I tried to point out how ludicrous it was that I had to decide where I was going to take my son based on a diagnosis code, when the whole point of taking him anywhere is to get the goddam diagnosis in the first place. Basically it becomes a sadistic game show in which I was an unwilling contestant being forced to choose door #1 or door #2, with my child's health in the balance.

Now, this post isn't just to bitch about UMR (the third party administrator of the health plan), although they have given plenty of reason to do so (and not just in these instances). I actually want to address something that I see as a larger problem in American society that seems to have taken root over the past fifteen years or so.

More and more I see the onus of virtually every action -- whether it has to do with health care, environmental regulations, safety regulations, financial regulations -- being placed on the average American. It's as if corporations and governmental institutions have discovered a butterfly effect of blame, a sort "six degrees of separation", only instead of Kevin Bacon, it's "six degrees of separation from it's your own damned fault, loser".

Consider my Achilles tendon: the position of UMR is that the claim was not paid because should have a) not only memorized all the finer points of the health plan, but also the relationships between this health plan, the dozen or so hospitals in the area, and myriad support companies (medical device houses, laboratories, etc.), or 2) had all this documentation on my person at all times so that, in the event something happened, I could make "an informed choice".

Sadly, this "Up Yours, American Citizen" butterfly effect was legitimized by the Supreme Court in the beginning of July, 2014. First there was the Hobby Lobby decision in the end of June, which said that, not only are corporations people, but they can be self-righteous, overbearing, uptight, meddling prigs as well (I might be paraphrasing just a wee bit). Hobby Lobby was told they could submit EBSA Form 700, which states that providing contraceptive coverage goes against their belief system. This coverage would then be provided to their employees at no cost to Hobby Lobby through government subsidies provided directly to the insurance companies.

Okay, fine. I don't like it, because it opened the door to all sorts of discrimination be wrapped up in the mantle of "religious belief" (and institutionalized religion has a demonstrated history of tolerance, fairness, and openness, right?), but it seems like an okay compromise ... for now. But then John Roberts and Friends went too far.

A few days later, the Supremes handed down an opinion in the case of Wheaton College v. Sylvia Burwell. This little nugget of joy validated Wheaton's position that completing EBSA Form 700 was in itself an undue burden to their religious freedom, because they would then be complicit in someone else providing contraception coverage that Wheaton didn't believe in.

I can only assume that, at that point, Wheaton College collapsed onto a fainting couch, fanning itself delicately while calling for a glass of iced tea.

This is only the beginning. Pretty soon, corporations will master the art of following the chains of causation back to the average American, who will be forced to purchase health insurance, auto insurance, homeowner's insurance, life insurance, death insurance, bicycle insurance, skateboard insurance, twisting-your-ankle-on-a-gravel-driveway insurance, catastrophic appliance failure insurance, not-so-catastrophic-but-really-annoying appliance malfunction insurance, insurance insurance (to cover you in case your insurance lapses because you couldn't pay the premiums), none of which will actually pay out anything if you make a claim because they will instead be able to follow some chain of cause-and-effect to a point where you failed to do something, or did something wrong, or went to the wrong place, or went at the wrong time, or didn't sign the form correctly, or you did sign it correctly but you used the wrong color ink, or you used the right color ink, but the wrong brand, and use this minor error as a hook on which to hang the denial of the claim.

And the Supreme Court will uphold it. Then the Democrats will denounce it, which will cause Darrell Issa to hold another hearing on Benghazi or the IRS or Michelle Obama's bare shoulders or some idiot thing, and the Fox News talking Beanie Babies will start shrieking about how the Democrats are trying to cover something up, and the MSNBC talking Beanie Babies will start barking that the Fox News people are a bunch of mouth-breathing, slack-jawed yokels, and Fox News will respond with allegations that everyone at MSNBC is a Marxist and a Muslim and an atheist (and yes, I know you can't be a Muslim and an atheist at the same time ... tell that to the right-wing yahoo that started yelling at me on Facebook), then Wolf Blitzer will walk into some 3D simulation of Samuel Alito's colon and start pointing out polyps with a laser pointer. I gotta lie down.

A Path Forward

The Democratic primaries are heating up, and I am already seeing purity tests of various stripes filtering across the intertubes. Bernie ...