Bills bills bills
Wednesday, April 8 2009
I grabbed this from my insurer’s website; the columns of dollar figures are (from left to right) the charge amount, the payment amount, and the patient’s responsibility, all from a single order I placed for medical supplies on February 2nd.
I’m fortunate that my insurance covers these supplies 100% – no co-pay, no deductible; however, the insurer requires me to order them from this supplier, or they won’t cover anything. If it were up to me, I would probably use a different supplier, but that’s a different post. What’s relevant here is that Insurer and Supplier have some sort of sweetheart deal for my business. I have had the same Insurer for 5 years, and I have been ordering the same supplies from Supplier more than two years.
I looked up these records because I got a call yesterday from Supplier stating that Insurer requires me to pay a $300 deductible and 10% co-pay on an order I placed earlier this week. So I logged on to Insurer’s website and confirmed that my supplies are 100% covered – just as they have always been for the last two years. I called Supplier back and asked them to double-check. They called Insurer and verified that yes, indeed, I am 100% covered.
While on hold to Supplier, I looked at my past benefits from Insurer and bills from Supplier, and found that I had never been charged a co-pay before. That “$41.70″ in patient responsibility? I never got a bill for that. But I also discovered that Supplier had to submit parts of this bill five separate times, and only got paid twice. As far as I can tell, the total billed by Supplier for the order was $1316.80, for which Insurer paid only $506.70 (and the I, the patient, paid nothing). I have no idea which number represents the real value of the supplies; I am quite certain I would get charged the full $1316.80 for them if I was paying out-of-pocket. As far as I can tell, the most recent charge (for $115.80 on 2/27/09) never got paid at all.
I looked at some of the charges that were “processed” but not “paid” – i.e. rejected. They’re full of spurious error codes – “authorization required – not found”, “not covered”, etc. Obviously, these aren’t real rejections – just stalling tactics designed to delay or avoid payment for the benefits Insurer is obliged to provide. I also downloaded all of my 2008 charges and payments into a spreadsheet. Just from Supplier, the charges totaled $11,550, for which Insurer paid $4,810. That’s 42% of the retail charges – i.e. less than half of what I would pay out-of-pocket. (My total charges to Insurer for 2008 were around $15,000, for which they paid $6,000.)
I can’t afford $11,550 for my supplies – but I might be able to afford $4,810. But since the Supplier shifts some of the underpayment from Insurer to the uninsured customer, I can’t get the same price as Insurer. So instead, I pay Insurer $5,304 in premiums, some of which goes towards administrative staff whose whole purpose is to delay and dodge payment to Supplier, who has an entire department whose whole purpose to is to extract payments from Insurer. And whatever cost I incur to either company, both are turning a nice profit; obviously, all this somehow works out for them.
But for me as the patient, it strikes me as a lot of friction and waste – especially given the prior agreement these two companies have for each others’ business. I know the private sector is supposed to be more efficient than the public sector, but I just don’t see it where my health is concerned.
