It’s a trick question for some of you. When I ask if the problem is with our insurer, our provider, or the lab that runs our tests. Some of you would just say it’s Obama’s fault. Or my fault. Truth is, I would love to blame Obama or myself, since life would be so much easier. The problem is that the only real blame IS with one, two, or all of the companies, but the system makes it virtually impossible to know which ones. 

We’re not talking thousands of dollars and debt collectors harassing us. In the grand scheme of things, the issues we’re having with United Healthcare, Baptist Primary Care, and LabCorp are small potatoes. However, when you start to imagine all the people in our country who are likely facing similar concerns, you start to wonder how the scam works, who’s in charge, and who makes the most. This isn't significant enough to file lawsuits or waste more time than we've already done, which is why an article that will be seen by many people, including attorney generals and politicians, might be the best course of action, since (as you'll see) no action seems to happen within the parameters afforded consumers. 

 

Here’s the basic setup. My wife went to a yearly physical, part of the free, preventive benefit afforded to all people with healthcare in our country. Our insurer is required by law to pay for this yearly checkup. The doctor’s office ordered blood work, which was done by LabCorp. No problem. No copay. Nothing out of the ordinary. 

Months later, we received a bill for $32 for the lab work. It was due almost immediately. This is funny, since it took months to send the bill out. My wife knew we should not have to pay for a free yearly doctor’s appointment, so she called the insurance company, who told her it was the way the tests were coded. So she called the doctor’s office who told her insurers should cover it because it was for the yearly appointment. So she called the insurer back, who told her to try LabCorp. So on and so forth. Basically, the insurer said she could appeal the charge, but the tests run were diagnostic rather than preventative. The case ended up going into the appeal process, and the charge was upheld. Neither the doctor’s office nor LabCorp would change the coding of the tests (they said it was illegal), and neither could explain why a preventative check up test would have been partially denied. Billing told my wife it was the doctor, who said it was billing, who said there was an office manager to talk to, who never seemed to exist.

Furthermore, United Healthcare said we needed all codes for any services before they would be done, while the doctor’s office said they would not do that. Added into the mix were several ignored messages from my wife to Pam in billing, who I am sure does something at BPC. Even though UH is based in Minnesota, most of the people we talked to were not in America, though the final decision to stick us with the bill was from a doctor in America. Anyhow, can you imagine standing in a doctor’s office and asking for every code for every test that might be run, then calling your insurer for pre-approval for each one? That’s what United Healthcare expects us to do, which is kind of silly.

Later, we received an EOB that seemed to indicate that our kids’ physicals would include urine tests not fully covered. Not a huge charge again at under $10 a kid, but think about ripping every parent off in America for $10 a kid at 70 million kids and you can see why the system is fine with charging us for a free physical. Stick every adult with $30 in charges for the same free service, and you’re looking at another 250 million people and you’re looking at an extra $7.5 billion to help cover those pesky preventative visits. By the way, I am positive it’s ILLEGAL for someone along the line to enact these charges, but I am not certain where it’s happening and which CEO is benefitting from the policy.

I know, not everyone has crappy United Healthcare insurance, and not everyone gets a physical each year. But there are tons of people who would see a $30 charge and just pay it. In fact, we received a charge over the summer that was 8 months old and from our previous insurance company; what else could we really do? My wife spent hours of her free time on the phone trying to get this ridiculous fee waived. The fact that the insurer took it all the way through an appeal to deny it means it’s willing to spend hundreds, if not thousands, of dollars to fight anyone who might question a small fee. I am sure the insurer believes it taught us a good lesson. The actual decision, which was like a lawyery-type form, indicated that there were problems brought to the attention of the company but that those were irrelevant to whether or not the lab tests would be covered. Maybe this is progress, but LabCorp and Baptist Primary Care have told us that the items should have been covered by insurance. Then again, I’m not sure if we can really trust Pam from billing.

Taking it all to the next episode, my wife booked me a yearly physical because I don’t book my own. She made a stink about needing codes ahead of time. Baptist Primary Care called me and told me I would have lab work done ahead of the appointment. The nurse said that they would bill the labs as diagnostic rather than preventative and that I could call my insurer to see if it covers the labs. I told the woman on the phone that my insurer would not cover them, and I had to tell her twice before she reluctantly changed the lab to preventative (at least she claimed she would change them). This, it seemed, was a smoking gun: Baptist Primary Care was ordering labs for a preventative appointment as diagnostic, presumably because “some insurers cover the diagnostic tests.” It was implied that the tests were actually the same, or at least very similar. This is where the fraud seems to be happening. You’ve got a lab that wants to test as much as it can and a doctor’s office seemingly coding the tests for that purpose, assuming most insurers will pay the bill. Either that or the insured people won’t want to deal with the hassle. Or get denied after review and pay anyhow.

Yes, I would be a happy person if United Healthcare and all other insurers were no longer in operation, but for all their faults, I’m thinking that the insurer IS following the letter of the law here, which, of course, is the way insurance companies rip us off legally. I’m actually more worried about my doctor’s office and lab right now, especially since there’s been a lack of transparency when it comes to codes used, whether codes can be changed, and the actual cost of anything at all. Really, you would not go into a restaurant (or any other business) and place an order without knowing how much that purchase was going to cost, paying whatever the bill might be, and then having to deal with Pam in billing a few months later. Yet we show up to doctors’ offices with no clue as to prices or reasons for those prices, and then codes are used in order to, presumably, take a little extra off the top. Immoral, unethical, and illegal. Those are words that should be saved for insurance companies and politicians, not for people in the healthcare industry.

I told my wife flat-out that if the insurer does not cover something that is coded improperly at the doctor’s office (because it’s within the insurer’s right to do so), then the doctor’s office or lab needs to reimburse for services not ordered from the menu. Also, I want to clarify that I’m not accusing anyone of knowingly breaking the law here. I assume there’s an attitude of “It’s always been that way,” when it comes to doctors billing patients. And there’s probably an attitude of Obama ruining a good thing that permeates through the halls of doctors’ offices, labs, and insurance companies. As a former public school teacher, I really look forward to the day when a national healthcare system publishes all the salaries of all the people providing healthcare for those of us who have paid huge percentages of our salaries into a flawed system that has yet to be fixed. My own paltry salary was published every year of my career, and people still complained that I made too much money, so good luck healthcare employees.

My advice isn’t to fight for your right to know how much your doctor charges or fight the insurance companies to pay for the services promised. It’s not to open an investigation into who’s bilking the system in this or any other case. My advice is to take our place as a First World Country and create a national healthcare system that simply covers yearly checkups, pre-existing conditions, life and death, sickness and health. We need to stand up and claim our rights to life, liberty, and the pursuit of happiness. And we need everyone who’s ever been a victim of the system to stop blaming themselves and thinking they are servants to a system. The healthcare system in America, its labs, doctors, and insurance companies--all are servants to us. Even those who drive Porsches and live in beach mansions (or become governor of Florida). 

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