As if the world needed another example of how the American health insurance system is completely insane, maddening, inefficient…I mean, we’ve all seen Sicko, right? But let me just share the private hell I’ve been through recently. I’d like to tell you what happened yesterday, but to do that, I have to go back a month or two.
In November my mother was hospitalized, and then spent time in a rehab hospital. During that time, she had a CT scan that diagnosed blood clots in her lungs. Medicare had approved my mother’s stay in the rehab hospital and, presumably, the treatments and diagnostic exams she received while there.
In mid-December I received a letter from the hospital informing me that Medicare had refused to pay for the CT scan because they said my mother was enrolled in a hospice. Would I please send them the address of the hospice, so they could bill them? I called the hospital, told them mom was not in a hospice, and told them I would call Medicare to straighten this out. I went through my mother’s Medicare statements and found other services with notations on them that Medicare refused to pay for them because, they said, mom was in a hospice.
I called Medicare. After wading through the byzantine voice menu, I finally got someone who told me that Medicare does not care if I am my mother’s power of attorney; Medicare has its own form that must be filled out and signed by my mother authorizing me to take care of her Medicare business. She would be happy to send me the form. According to her computer, it should be able to be mailed out to me on…January 6, 2009. WTF? I have to wait three weeks for them to even mail out the form? Isn’t it available on the web? Can’t I just download it and print it out? This request sent the women on the phone into a tailspin. She had to put me on hold and consult with a supervisor three times, before finally reporting back to me in triumph that yes, amazingly, the form WAS available on the web!
So I got the form, printed it out, filled it out, mailed it to mom with instructions where she should sign it, included a stamped, addressed envelope for her to send it off in, and waited. And waited. And waited. Last week, I finally received notice from Medicare that they had gotten the form and had deigned to grant me approval to handle my mother’s Medicare-related financial affairs. The same mail brought a $1400 bill from the hospital for the CT scan, with somewhat aggressive language about my need to pay it promptly.
I called the hospital again. I explained that I had just gotten permission to talk to Medicare about the bill and would call them that day. They agreed to put a two-week extension into the file.
I called Medicare. Why, I wanted to know, is Medicare acting like my mother is in hospice – when Medicare in fact forced her discharge from hospice in December of 2007? Why are they not paying for the CT scan and the other services? After 45 minutes on the phone and much digging in the records by a very nice and helpful woman, the following information was uncovered: (1) Medicare shows that my mother is not in hospice, was discharged from hospice in December 2007. (2) Medicare received a bill for the CT scan for $171 and made payment for it. (3) The other services I inquired about – all listed as paid in the Medicare records. Why am I receiving statements from Medicare saying Medicare refuses to pay for these services because mom is in a hospice? The nice woman on the phone had no freakin’ idea. She also had no record of Medicare receiving a bill for a CT scan for $1400.
I called the hospital again. I told the person on the phone there what I had learned from Medicare. This woman got a bit peeved at me, insisting that Medicare had rejected the claim because mom was in hospice and that the bill was for $1400. I asked the cranky lady – what am I supposed to do here? Medicare says they have no record of this $1400 claim, and that their records show mom is NOT in a hospice. Medicare says they paid for a CT scan claim that was filed in the amount of $171. How in the world am I supposed to resolve this? Cranky Lady said she’d go check the records again.
I have no idea what she found out, but when she came back, she was less cranky. She said the $171 was probably the doctor’s charge, not the CT charge (even though the statements I have from Medicare and Blue Cross show the hospital, and not a doctor’s name, associated with the $171, and even though it says “CT scan” next to it.) She said she would resubmit the claim with a note attached saying that Medicare acknowledges responsibility for the patient on the date of service.
I await to see what happens next. But really, none of the mysteries are solved. Why am I receiving statements from Medicare with notes about mom being in hospice, on services that Medicare has gone ahead and paid for anyway? How are these notes turning up when, according to the woman who looked, mom’s records with Medicare show she is NOT in hospice? If the records show that, then how was the claim from the hospital rejected? If the claim was rejected, why doesn’t Medicare have any record of the rejected claim?
So far this saga has required five phone calls to Medicare and the hospital; several to my mother to explain what she needed to do with the form both before I sent it to her and after it arrived; and hours of my time on the phone, printing out documents, filling out forms, searching through Medicare and Blue Cross statements, and trying to decipher those completely non-intuitive statements. And I still don’t know what the hell is going on, and the hospital still hasn’t been paid. This can’t possibly be any sensible way to run a health insurance system.
And through all this I keep thinking: what if my mother had no one like me to help her sort through all this? What if my family had no one like me – i.e., someone without a job – able to devote the extensive time required, often during working hours, for just one interaction with the health insurance system?
Then finally I think: And we’re among the lucky ones. Because my mother has really, really good health insurance. Doctors and nurses and office staff tell me this over and over when I interact with them on her behalf.
So, I know you’re very busy, President Obama, but if you wouldn’t mind fixing the health insurance system NOW, I’m sure we* would all really, really appreciate it.
*except the rightwing wackaloons for whom a non-byzantine health insurance system represents the end of civilization as we know it.