So there I was, enjoying the colonoscopy I had been putting off for about seven years (until age 62). Any enjoyment, however, came from knowing that I was finally getting something accomplished that was foolish to postpone -- especially for a hypochondriac like me.
My concerns about the competence of my practitioners were assuaged when my foreign-born physician assured me that his associates were "the crop of the cream." I figured out what he meant, and he was right. They were excellent.
That was back in February. I am still trying to straighten out the bill, which is turning out to be an object lesson in the world of U.S. medicine today.
The actual cost of the procedure for anyone not having insurance was $2,458. That was my initial bill. However, Blue Cross has negotiated a fee of $514 for the procedure, so that's all the clinic will get.
Meanwhile, my company has a high-deductible health plan with a $1,250 annual deductible. With all the money the company saves in health insurance premiums, we turn around and give each employee (including me) about $2,000 of tax-free cafeteria plan money that more than offsets what we have to pay in deductibles.
Our company's total cost of health insurance (including these cafeteria plan deposits) has remained constant over the past five years, while elsewhere the costs just skyrocket.
Since the clinic saw that I had a high deductible, they made me pay $1,200 up front and now I am waiting ... and waiting ... to get back everything that I have spent. The clinic was overpaid by $686 thanks to my $1,200 payment. It is now the end of July, and I'm still waiting for this to get straightened out.
When the dust settles, I will effectively pay $514, but my company cafeteria plan will reimburse me for this payment. I won't pay any taxes on the $514, so it will be just like having an insurance company pay the bill.
My company actually administers these cafeteria plans for hundreds of Bay Area companies. The people trying to straighten out my bill are my own trained professionals who work with these problems every day. If we're having trouble battling the system, how on earth does the average person manage to extract what they are owed out of their health insurance carrier?
I have to guess that millions of reimbursements owed by a combination of the insurance industry and health care providers just never get paid. The system is too complex, and people undoubtedly just resign themselves to accepting less than they are owed because they don't want to remain on hold for another 30 minutes.
I have heard a few anecdotal success stories told by people who successfully badgered a claims payment person over the phone until they just agreed to pay the claim. It's beginning to feel like the system might be run like the mirror image of a meter maid ticket quota. People working in health insurance claims probably get bonuses for the number of claims they manage to avoid paying.
Meanwhile, United Health reported last week that its quarterly profits are up 25 percent over the same quarter last year. This is the same company that paid its president $1.6 billion last year. (Billion is not a misprint.) It's enough to make anyone just switch to Kaiser and hope for the best.
This dysfunctional system should be of great concern to people who have left the work force and who are too young to be covered by Medicare. This is the "donut hole" in the health insurance industry that really needs attention. When we read about the various states adopting, or at least considering, universal coverage for all residents, it is this group of formerly productive members of the work force that are my biggest concern.
True, there are 6 million uninsured people in California right now, but we all pay for their coverage to at least some extent if they are impoverished and go to county emergency rooms for treatment.
Actually, people with no health insurance, but who have assets to attach, are charged astronomical rates for services and effectively subsidize the cost of those with no insurance. Responsible residents who have worked forever and who are just trapped by the system for a few years deserve something better.
If you see yourself with the potential for this to happen, and you are insurable thanks to good health, it can pay to buy an individual health policy with a high deductible even if you're still working and covered today. If you are covered as a dependent of an insured worker, check to see what you are charged for that coverage and consider spending the money on something independent of the job. That way, at least one of you is guaranteed future inexpensive coverage if the job ends. You can check out rates at A href="www.ehealthinsurance.com">www.ehealthinsurance.com.
Finally, don't hesitate to practice preventive medicine regardless of how inconvenient some of these experiences might be. After all the brain power we apply to managing our investments, it will be all for nothing if we fail to nip a serious health problem in the bud.