Pardon my rant, but since there is more than a bit of talk about healthcare right now, and having had a moderate amount of interaction with the healthcare system, I wanted to share something that happened to me today.
In May my daughter had a procedure done at CHOP. It was a dental procedure that is medically necessary because she was born with a cleft-lip and palate. She’s had it done before and usually after a call from CHOP the claim is paid by the insurer. So CHOP submits, Aetna declines, I get a bill for $7000. I call CHOP, they say they’ll take care of it with Aetna, and today I get a bill for $7000. I call CHOP, CHOP says they can’t make out-going calls, but if I can call Aetna, they can three way to CHOP and they’d be happy to explain it. I call Aetna, get a computer that asks questions for five minutes and when I finally have the opportunity to speak with a representative I’m told that to serve me better all of customer service is receiving training and to call back in an hour. The phone then goes dead. Thirty minutes later I call, go through the same chat with the computer, and get the exact same message – and click.
I went on the web site and could find no alternative number to call.
The hospital knows that the insurance company should pay the claim, yet out of ‘process’ they bill the patient. I have until the end of the month to pay and then it automatically goes to a collection agency. How do I know? The last time they told me they’d flagged my account and not to worry, it automatically went to a collection agency. Yes it was resolved, but it wouldn’t have been an issue if the insurance company had a better understanding of their own plan!
Out of curiosity, I decided to see what Aetna pays its CEO for this ‘performance’. Ron Williams, CEO, Aetna, earned $24-$30 MILLION dollars in 2008 (data available here and here) depending on the source you visit.
Unbelievable!
3 comments:
Sounds like a billing issue which we have run into frequently with our insurance. It will be taken care of. I ask, however, why completely change the healthcare system for something like this? Has your daughter received quality care over the years? You said this was the first time there was an issue. As for the CEO making 30 million - again what does that have to do with the level of quality care your daughter received. It's become very trendy to go after these "evil" CEOs who run companies that hire 10's of thousands of employees. They are NOT the reason for your billing issues nor why insurance is so expensive. Look beyond what the agenda is spewing. Your daughter is in my thoughts and prayers.
Blue Cross or Aetna, they screw up.
Actually, its not so much that they screw up as much as they deny claims and put the cost on the patient, only later paying once calls are made, parties are brought together, and its deemed to be medically necessary.
These may not be the most common procedures, but they aren't unique either.
Yesterday, when I could get through to customer service, I spent an hour on the phone with CHOP and Aetna. CHOPs code isn't accepted by Aetna. Aetna wanted CHOP to change the code. CHOP won't change its codes. Therefore Aetna needs to request all medical records to determine if it was a medically necessary procedure.
I've been sent to a collection agency already while a dispute was going on and threatened with it two other times. In one instance the dispute went on for a year.
In every case they ultimately agreed.
I don't believe it is a billing issue, it is the plan construction. It is the decision as to whether or not treatment should be provided by the insurance company.
Denying procedures to individuals is about cost savings.
When companies routinely deny health treatment, yet can compensate their CEO to this extent, I have a problem with it.
The fundamental problem with healthcare is that we wait until there is an issue and try to fix it instead of trying to be proactive and stopping them from arising.
I agree that government isn't the best option, but keep in mind they already run half of healthcare or more.
As a political issue people get upset with pharma, yet it only accounts for 10% of healthcare spending. Problem is it is most often a cost that isn't covered and since people pay out of pocket it becomes a political issue (having said that there are instances of abuse, like generic allergy products whose co-pay is higher than the cost of the product).
Insurance is one component of a large problem. Denying healthcare that is medically necessary for a child is wrong, and yet I've seen it happen time and again only to get corrected later.
I've probably wasted weeks of my life trying to resolve these issues. Waste of their staff time and mine. Would much rather that money go to treating people.
Enough rambling, thanks for the note and thoughts. BTW our daughter is fine, but with a cleft-lip and palate it is a long repair process that we appear to be getting toward the end of.
Aetna is the worst of the worst in all phases of subscriber service. They appeal to the employer's need to control cost, and service delivery like you have experienced is how they get keep those costs down.
If this is your first problem, lucky you. I have worked for more than one company that dumped Aetna for their poor service.
As for the trend to go after "Evil CEO's", that is where the buck stops. They are the people who benefit from offshoring of call centers, from contracting work to mostly disinterested third party administrators, from laying off highly-trained service delivery personnel, from "PRESS ONE FOR..." phone systems, and ultimately from allowing the implementation of the policy to "make the subscriber jump through every possible hoop" before acknowledging responsibility for the claim, because enough of them will tire of the process and just pay the bill themselves". They manage service down in order to make profitibility goals that deliver their excessive compensation.
Normally, the natural application of free market principles should take care of this problem. But, health insurance is not a pure free market product. That is why, and where, the reform is needed.
Glad to hear you daughter is nearing a successful end to her journey.
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