Saturday, November 03, 2007

The World's Greatest Health System

It's really quite dizzying how deranged the health insurance industry can be. But of course, in even just a proto-fascist state, the corporation is the paramount entity and we -- citizens, people -- are just here to be sucked dry by them.

Kos has a story:
My daughter was born on April 7th of this year. We went to Alta Bates hospital, in Berkeley, which was pre-approved by our insurance provider, Blue Shield.

At the hospital, as is often the case in baby deliveries, my wife asked for and received an epidural. There was one Anesthesiologist in the entire hospital.

That anesthesiologist charged $1,032 for his services, which was passed on to Blue Shield.

After an initial refusal to pay, followed by several weeks of back and forth, they sent a letter dated May 14th that says:
This is in response to your inquiry concerning services provided by East Bay Anesthesiologist on April 07, 2007 in the amount of $1,032.00.

You contacted us to request that claim process at the preferred rate. After careful consideration of this matter, we will, in this instance only, administratively approve payment for the above mentioned services. The claim(s) in question will be processed and an Explanation of Benefits will be sent shortly for you.

Please be advised that our determination in no way alters the terms and conditions of the subscriber's plan. In making this decision, we do not waive any of our rights to enforce the provisions of the subscriber's plan on this or any other service plan or claim.
Well, that ended well, didn't it? Of course not. This is the modern medical system we're talking about.

Since that time, Blue Shield paid about $400 of that total, and refuses to pay the rest. Meanwhile, the anesthesiologist's office keeps threatening to send us to collections. We've literally called Blue Shield several times every single month since May, asking why they wouldn't pay the balance. Each time, they assured us they would.

Then today, a service rep said they would pay no more. They said that this sentence applied:
You contacted us to request that claim process at the preferred rate.
Their out is the line "preferred rate". And the preferred rate for that procedure was apparently around $400.

Of course, we never asked them to process this at the "preferred rate". We ask them to pay for the service. That's why we're paying over $800/month in insurance premiums. To be insured.

It gets worse, the office of the anesthesiologist has letters from Blue Shield claiming that the insurance company had sent us the money directly, so to bill us for the services. Of course, we never received such money. No such checks were ever cashed (which would be easy enough to verify if they were really interested in the truth, and not shirking their duties).

So they lie to us, claiming for seven months that they'll cover the procedure. They lie to the anesthesiologist's office, claiming they've already paid us the amount owed, and to bill us directly.

And now, finally, they truth comes out -- they have a problem paying what's owed and will refuse to do so, even though they sent us a letter saying they would.

As my wife tried to deal with Blue Shield, she asked the costumer service rep what her name was. She said, "Diane." My wife asked for her last name. The woman said, "I don't have to give you that!"

Then she hung up.


How could a government-run service be any worse than these unaccountable, unethical, disgusting creeps?

I can't wait to see all the stuff they'll refuse to pay over my abdominal pain.

Update: You know you suck when entire campaigns like this are waged against you.
(Illo link.)

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