Doctor! Doctor! My private health insurance policy is driving me crazy!

4 August 2005
Only in en
A warning to Europe from across the Atlantic: are you sure you want a privatized healthcare system? Where the sick play phone tag with disembodied insurance brokers? Where over-cautious doctors insure themselves against malpractice claims? Where patients have to ask their insurers for permission to go to hospital? It's not only the inconvenience, it's the cost of the whole thing, says George Blecher.

Whenever I leave New York on a long trip, I tell the neighbor who takes in my mail not to pay any of my doctor bills – they’re sure to be wrong. She smiles painfully; she knows. When I come back, I prepare myself for a good two days of pouring over the collected bills, trying to dig myself out from under them.

Not that my health is bad: it’s just that if I’ve had occasion to see a doctor, dentist, or therapist in the past six months, I’m still trying to work out the interface between the “providers,” the private insurance companies, and me.

This is how it works in my case, or cases. (There are as many approaches to health care in the US as there are citizens, where 40,000,000 of us have no medical insurance at all.) I can’t simply walk into a doctor’s office, show my I.D., and get treated. I have to show proof of medical insurance, and after my visit, which is likely to cost around $150, the doctor’s assistants send the bill to my “primary” insurance company, which is supposed to refund part of the fee to the doctor and send me another bill for the rest. In most cases, however, this doesn’t happen; the bill makes its way directly to me. When I call up to correct the mistake, I don’t speak to the doctor’s office but to a separate billing service, whose sole purpose is to collect the doctor’s fees. It may take me days to get past their recorded message; in the meantime, we’ll play phone tag, a popular New York game. When I finally reach a live person, an unfailingly cheerful, last-days-of-Rome voice amused by the absurdity of her task tells me that of course I don’t have to pay the bill, they’ll send it right on to the insurance company. No problem.

There are several problems. In some cases, after receiving some money from Insurance Company A, the doctor’s billing service will send the bill further to Insurance Company B, my “secondary” insurance, which is supposed to reimburse a portion of the amount that Insurance Company A hasn’t paid. But usually this doesn’t happen either; most of the time, they send the bill again to me. This time I’ll have to pay it, then send a copy of that bill, a copy of the original bill, a copy of the record of Insurance Company A’s payment, and a request for payment to Insurance Company B, which will eventually pay me a few more pennies, though it’s possible that by mistake they’ll send the money to the doctor’s billing service, and I’ll have a few more days of telephone tag to correct the mistake. All through these circles of Hell I’ll keep a thickening file of every transaction so that if anything doesn’t reach its destination, I can refile the claim forms and try to get some money back.

I am not making this up.

The doctor’s billing office isn’t the only problematic nexus in the system. Half the phone calls I’ll make – to say nothing of faxes of lost documents, copies of claim forms and bills – will be to Insurance Companies A and B, asking them why they haven’t paid the doctor or me, why they’ve paid so little, why they’re requesting more information about my illness (there’s a universal coding system that’s already told them everything they need to know) or about claims that have been settled and ones that I never filed. Usually the voices on the other end are tired and apologetic; they don’t know why they sent me all this extra paperwork, the computer’s been acting strange lately, they’ll look into it. (Some of my calls will be about problems that they’ve already looked into, with unsatisfactory results.) At the end of each phone call I’ll have to make a note of whom I spoke to (they’ll give me only their first names), and when. My file grows thicker.

I am not making this up.

If, God forbid, I need some hospital procedure, I’m required to make a phone call to Insurance Company A for permission to go into the hospital; they may want a second opinion. When I arrive at the hospital’s front desk, I’ll have to show proof that I’m a subscriber not only to Insurance Companies A and B, but also to Insurance Company C, which handles in-patient hospital care. If my problem is serious enough, I’ll have to fall back on Insurance Company D, which handles my “catastrophe insurance,” and if I need home nursing care after my hospital stay, I’ll have to dig up my long-term care policy, you know, the one with Insurance Company E. Of course dental work involves yet another insurance company: Company F.

I am not making any of this up.

We haven’t yet touched on the central issue: the cost of this Byzantine system. I consider myself lucky: because I was a professor for a number of years, much of the cost of my insurance is “low” because of group rates, and some of it is even paid for by my union. Individuals without an affiliation (free-lancers, etc.) face a much darker situation: the cost of insurance comparable to mine, if they can get it at all – for a completely healthy 25 year old in New York City – will be around $8,000 per year. No doubt you have American friends and relatives who’ve told you that they’ve taken jobs simply because they provide decent health insurance.

Of course, unlike most Europeans –and many Americans, who are under so-called “managed care” plans – I have the freedom to go to any doctor I like, or rather any doctor who’s willing to give me a five minute appointment sometime in the next six months. In New York, the initial visit to a specialist will be around $5-600, about 20 per cent of which will be covered by all my insurances. He or she is likely to ask me to go through a series of tests far more extensive than a European doctor would recommend, and after the tests he’s far more likely to put me on long-term medication. (A portion of the controversy in American medicine these days is about tests and medicines that do more harm than good.) Though some would accuse the doctors of colluding with the pharmaceutical industry, there’s a simpler and more insidious reason: the cost of doctors’ insurance against their patients. If a doctor doesn’t cover himself by giving all likely tests and medicines, he leaves himself open to lawsuits, and irregardless of whether he wins or loses the lawsuit, his insurance premiums will go up; insurance for surgeons, for instance, has risen to hundreds of thousands of dollars per year. Just as I have to protect myself by having multiple insurance policies, the doctor has to have insurance policies to protect himself from me.

Are there other problems in the American health care system? You bet. Among them are the degraded state of many of our hospitals, the high cost of drugs, and the profound differences in the health care of rich and poor: some hospitals are said to have secret sections and doctors for wealthy donors. What does it all add up to? An adversarial relationship between people who should be on the same side. Frustration, worry, immense amounts of wasted time. Ill health.

Dear old socialized Europe, which seems to be losing faith in its welfare states, are you sure you want to switch to a system like ours?

Published 4 August 2005

Original in English
First published in

© George Blecher Eurozine

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