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the Blue Cross/Blue Shield blues

I’m dealing with a situation with my insurance company that simply should not be allowed to happen. It’s not the insurance company’s fault, I don’t think, or my doctor’s, or even mine. I’m not trying to point an accusing finger at any of the individual players involved. That doesn’t make it okay.

A little over a year ago, I was diagnosed with tendonitis due to too many hours spent hunched over a computer and library books, and too much pressure on my elbows due to an unfortunate habit of propping my head in my hands while reading.  Those problems are since fixed, but the thing about tendonitis is, once you acquire it, it’s fiendishly difficult to get over it in anything resembling a long term. It gets better, and then it gets worse. I’m functional, but quite often in a fair bit of pain when it’s a bad day. Which is why I’ve been in physical therapy for the last several months: a combination of pain management and building up muscles so it’s not such a huge problem.

I have a prescription documenting this, from my school’s health center which is the first gatekeeper in my student health insurance plan. I typically have to go there before getting seen by any kind of a specialist. Which is not unusual. I did that.

When my school’s health center suggested PT, I dutifully called up my insurance’s 1-800 number. Told them what my prescription was for. Got a referral to a specific PT clinic in my neighborhood. Went to said clinic, presented my insurance card, and was told they did indeed accept my insurance. My information was passed on to their billing department (this is one of several clinics in a chain, with one administrative office), and someone I have never met but I trust is fully competent at her job verified that i did have insurance their clinic accepted.

And so therapy began. Back in… June, I’m thinking? It was before summer school. Can’t remember how far before. But a while.

Come November, the clinic chain’s billing specialist told my clinic’s manager that my insurance hadn’t ever paid a cent for my care. First they said they needed something in writing that it wasn’t an accident (first I’d heard of it) and a treatment plan from my PT clinic, which they provided. At which point, said insurance informed my PT clinic that they weren’t paying for it because it was a long-term condition that couldn’t be treated in a certain number of sessions. Also because it wasn’t caused by an accident.

To be clear: I don’t mean that they weren’t willing to pay for any more treatment. I mean they’re also not willing to pay for any past treatment. Which means, despite the fact that I jumped through all the requisite hoops and had no indication from anyone that things weren’t handled smoothly, I may wind up on the hook for thousands of dollars in medical bills for an elbow that still requires periodic treatment going forward.

Also, while waiting for this whole mess to get sorted out I haven’t been in therapy (though I have been doing my exercises on my own, as I always do). So some old problems flared up again, enough that today I did a session at the no-insurance rate.

Obviously, I’m a bit irked because I feel like I’ve done everything I can and have been left with a rather raw deal. What’s truly maddening, though, is this: even if I had my medical bills paid, there’s still something very wrong about this system. I had to see at least two doctors I wouldn’t have had to see if not for insurance to get started. My “choice” in doctor was hemmed in by what doctors took my insurance, and I had my treatment halted abruptly for the better part of a month because of a billing snafu.

The thing is, though, this is just my experience of a system I’m coming to realize is fundamentally broken. Granted, my insurance isn’t great, and I would buy more comprehensive if I had it available to me (indeed, will under the ACA this summer if I don’t have a job with decent benefits). But even if I had the most comprehensive insurance around, it would still be insurance. It would still be a company whose business model was built on restricting my choice to only some doctors out of financial necessity, and that really, rationally, is best served by denying me treatment entirely. I would love a system where I get sick, go to a doctor, and my treatment is determined by her expertise rather than what my insurance company is willing to pay for. Also, where I can be sure I’ll actually not end up on the hook for major bills because the stars were out of alignments or the odds weren’t in my favor that day.

All of which leaves the obvious question why I bother with insurance, if it’s s awful. Setting aside the fact that it’s no longer legally an option to go uninsured, at least not without paying a fee, even before, it wasn’t really an economic possibility because doctor’s offices typically charge the insured less than they need to break even because they can’t afford to lose the business. Which typically means that the self-pay people end up subsidizing the insured people.  That bothers me.

As does the fear of what would happen if anything even marginally serious happened to me.

As does the thought I’m not just supposed to be seeing to myself, but making sure everyone around me has access to a doctor, and the closest my society comes to doing that seems to be through an insurance company that’s supposed to pay for your health-care to normalize the costs. It’s far from ideal, so very far, but checking out of this system doesn’t seem likely to actually help thing.

But really, at the end of the day? The fact that this is better than nothing at all doesn’t change the fact that this all feels very wrong somehow. I’m not sure what the better alternative is, but something still seems off about all this.

NB: My health insurance isn’t actually through Blue Cross/Blue Shield. That was me trying to be clever and play on words. I have no reason to think that company is any worse than nayone else.

Originally published at Faith Seeking Understanding. You can comment here or there.


( 4 comments — Leave a comment )
Dec. 3rd, 2013 03:14 am (UTC)
The solution is to extend Medicare to everyone regardless of age. But that will never float in this political climate.

And the compromise, which is not really that good, is now being compromised by the difficulties in its launch.
Dec. 3rd, 2013 03:24 am (UTC)
Over at FB, my first response to the insurance thing was to ask if Santa had a job in a country with single-payer health care in his red sack. And I mean it. I want a job in Canada or the UK or somewhere with a sane approach to this.

I guess I meant within the bounds of political realities, I don't know how to get to any humane way of providing medical care to everyone in America. And I don't see myself actually finding a job somewhere outside of America these days, what with my lack of degree or career experience. It's a depressing dose of reality.
Dec. 3rd, 2013 11:10 pm (UTC)
Stories like this are why when people in this country diss the NHS I always jump up and down and yell "You. Have. No. Idea. How. Lucky. We. Are!!!"

OK, we sometimes have to wait longer than ideal, and we don't always get much choice about the specialist we see (in theory these days we do, but in practice that only works for those middle-class, educated and articulate enough to do the research and make a fuss), and sometimes we are told that a particular drug treatment isn't available on the NHS because the improvement in health/extra months of life it would bring don't justify its cost, and we do have to pay for various extras like a lot of dental and optical treatment and a set charge for prescriptions, but...

(largely) free-at-point-of-use, (largely) decent quality healthcare (mostly) independent of ability to pay, funded through general taxation.

I don't think people who've never lived under any other system have any idea how fortunate we are.

(And sorry, that probably sounds smug and is entirely unhelpful. Bucketloads of sympathy for a very unfair plight, and I hope to goodness that since you can prove you checked your treatment would be covered before you started it, the insurer will back down from refusing to pay. Crazy.)

Edited at 2013-12-03 11:13 pm (UTC)
Dec. 3rd, 2013 11:50 pm (UTC)
It doesn't sound smug at all. But it does make me want so, so badly to live under a single-payer system or anything of the kind. That's part of what makes the grad school thing particularly frustrating, because I'm no longer really in the running for jobs in places other than my geographic area, much less in a decent country. Someday, hopefully, but not now.

I get that NHS isn't perfect, but the care I've received when I was on exchange in the UK was so much simpler, so much more accessible than anything I've experienced in the US, it doesn't even warrant the term comparison.

I'm definitely pushing for something to make this manageable. There's a possibility they'll at least cover the sessions I've already done, even if they won't pay for future ones (which is fine with me), or that I'll at least be able to work out a reduced rate with the doctor. I'm working on that. The fact that so much is up in the air now is a bit maddening, though.
( 4 comments — Leave a comment )



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