Category Archives: health insurance

I Have A Steaming Cup of STFU For HCA/Centennial

[UPDATE]:

Oh, God. It’s worse than we thought. I just heard two stories from people in my same insurance group that are as bad if not worse — both involving emergency care. One at Vanderbilt hospital.

Let me repeat: we all have excellent insurance. We have an HRA which pays 100% of the deductible. I’m not out one penny and the hospitals aren’t footing the bill for anyone. You will get your money from us. Leave us the fuck alone.

It appears the entire hospital system is trying to harass and bully fully insured patients into paying more/sooner. Hey fellas, if you have a beef about payment, take it up with AHIP. Patients shouldn’t be put in the middle of this.

More suckitude from the “best healthcare system in the world.” Baaah. I don’t know why we have to put up with this bullshit.

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Dear HCA/Centennial: I am beyond tired of you dicking me around on payment for a goddamn mammogram. You do this every year. The creative lengths you go to wrest payment from me, the patient, instead of waiting for BlueCross-BlueShield to pay you, as they do every year, has grown old.

You will get your money. You always get your money. You have never not gotten your money. I have top-notch insurance for a reason, one of them being so I don’t have to deal with some hospital billing office calling and sending me invoices when they haven’t even given my insurance company sufficient time to process payment. I’m just sick of it.

So this year I go in for services at the end of May, they billed insurance on June 3, and they sent me a bill on June 8. That’s barely time for BlueCross-BlueShield to receive the bill, let alone process it. I called the billing office and they apologized saying it was “a mistake” and I “shouldn’t have been sent a bill this soon.” Gee, ya think?

Thing is, a similar thing happened last year. I blogged about it here. That time it wasn’t “a mistake” but an “option.” I could pay now “if I wanted to” and have HCA pay me back when they got their payment from the insurance company.

Why the fuck would I want to do that?

Let me add, a neighbor of mine was in a horrific bicycle accident last year and got a whole bunch of diagnostic imaging services at HCA-Centennial. He told me they got the same “pay us now, if you want to” harassing phone calls. Followed by bills they knew they didn’t have to pay because it was covered by insurance. They wanted to know what that was about, too. They thought it was weird, too. It’s not just me.

You guys have to cut this out. It’s obnoxious and unnecessary. I”m sick of it.

I’m going to call my doctor and ask if someone else does mammograms in Nashville so I don’t have to deal with it anymore. I’m done with you people.

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I Don’t Understand This

Can one of my readers in the healthcare field please explain to me what “consumer-based lab testing” is? AHIP (America’s Health Insurance Plans) is holding its annual convention in Nashville right now and one of our local biz rags gave a brief rundown of what they’re discussing. “Consumer-based lab testing” came up and it sounds all shiny-sparkly-free-markety-“let’s all shop for our healthcare”-y. And I’m just trying to understand who this is for:

“Without consumer engagement, there is no pressure for prices to go down,” said Elizabeth Holmes, founder and CEO of Theranos.

Theranos, which Holmes founded in 2003 and has former Sen. Bill Frist as a board member, offers accessible and affordable lab testing, with transparent prices available on the company’s website. Holmes likened consumer-based lab testing to at-home pregnancy tests, and said by making lab testing more accessible, early detection becomes possible for patients who are not a part of the existing health care system.

“When prices are transparent and consumers are informed, competition flourishes,” Holmes said.

What the fuck does this mean? If you’re not part of the existing health care system, it’s because you’re either too poor (but not so poor as to qualify for Medicaid), or else you’re one of those young fools who thinks they’re invincible. So you’re gonna, what, get a blood test or a PAP smear or funny lump biopsied by “shopping around” for your labwork? Without a doctor’s referral? I don’t get it. Who’s taking the sample? If it’s a PAP or a biopsy, you need to see a doctor. So I’m just confused who would be “shopping around” for their labwork.

And is cost really the only issue when it comes to who is analyzing your lab work? Or even the most important issue? Isn’t accuracy kind of important, too? Even more important than cost? I mean, I can divine your labwork by gazing into a crystal ball and I’ll do it for $5. Don’t think I’d get many takers.

Or is she saying this is for people who are in the healthcare system? So that when I get my annual PAP smear or have a funny lump biopsied, I’m going to have to shop around and tell my doctor which lab I want processing my test sample? Like I have time for this? Like “consumer choice” is something I have time to deal with in my life? (And yes, I’ve already been down this road with Bill Frist and his infatuation with “shopping” for healthcare). Because again, cost is the only thing I’m supposed to care about?

Please tell me what I’m missing here. I swear to Goddess, Republican infatuation with “shopping” is so far removed from the way most of us navigate our daily lives. I do not want to shop for this shit. Who would? What consumers want, and deserve, is the absolute best healthcare, when they need it, without having to go bankrupt. Always and forever. That’s not shopping, that’s fixing our fucked up system.

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My Annual Healthcare Rant

It’s time for me to get my annual mammogram at the for-profit HCA/Centennial, which means it’s time for my annual rant about our for-profit healthcare system. I blogged about my experience last year, in which I was offered an opportunity to pay for the service out of pocket upfront, at no discernible benefit to me because it’s all going to be paid by my insurance anyway.

So this year I got the same “give me my money” phone call, which they laughably call “pre-registration.” I give them my name and address and other contact info (which they already have because it’s in their system) and then I get the rigamarole about how much the service will cost — this time she’s clear to say it’s “because my insurance hasn’t been verified.” Last year, they just told me the service would be $150. So I’m glad they’re at least clarifying the insurance angle. But still, I’m supposed to do what, exactly, with this information? Start selling off the family heirlooms? I have insurance, mammograms are covered, now go away, please.

And then 24 hours later I get yet another phone call from the same person who “pre-registered” me yesterday, to say my insurance has been verified. Which you’d think would be good news, but in HCA Land, it’s actually another opportunity for them to try to get my money. For a 20% discount, I can pay now! Yes, that’s actually the deal I was offered. I can pay for the service at 20% off now, or I can do nothing and my insurance company will pay the full price (repriced, but whatevs). I mean, my insurance pays 100%.

I mean, seriously, people? WTF? Why not just lower your prices 20% and then we can all reap the reward of lower insurance premiums?

I cannot believe this is going on.

Mr. Beale is furious. He wants to know, if I do pay now at the 20% discount, and then BlueCross/BlueShield remimburses at 100%, who gets that extra 20%? HCA?

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Is This A New Healthcare Scam Or What?

As you may recall, I recently went for my annual mammogram, which was quite an adventure. But now, dear friends, the adventure continues!

We’ve got really good insurance from BlueCross/BlueShield, so my annual exams of this type have always been covered 100%. But this time, for the first time ever, the hospital’s billing office called me prior to my appointment to “pre-check me in,” and also to let me know the cost would be “around $150.” I let them know my insurance has always paid for this in full and asked if they were sure about the charge? The woman on the phone sounded unconcerned, like this is something they routinely tell people without checking what their insurance plans call for, just a heads’ up of what they might need to expect. Or not, as the case may be.

I found that totally weird. If I hadn’t been doing this every year for a while and knew I was never charged, I might be a little freaked out. I’d especially be panicked if $150 was a make-or-break amount of money for my monthly budget, which it easily can be for a lot of folks. Especially the kinds of people not accustomed to shelling out large amounts of money on regular health services like mammograms. For example, people new to the healthcare market, thanks to Obamacare. Just sayin’.

As it happens, I get my mammogram and there’s no charge, as usual. The office said they’d file with insurance, as usual.

So imagine my surprise when about 4 days later I get a bill from the hospital! Again: this has never happened before! I assumed it was a bill I could ignore because BlueCross/BlueShield typically takes months to process claims. But the bill showed a discounted amount of around $143, and I’d had that phone call saying I should expect to pay around $150 … so I was a little confused. Again: if I hadn’t done this before and known not to be worried, I’d be in a panic.

So I called the hospital’s billing office and asked WTF is this thing I got in the mail. And get this: she says, “Oh, we just send that out in case you want to pay it. You don’t have to, but if you want to.”

Whaaaa…???

I asked her to clarify what she meant. “You mean, pay it and then have you pay me back when the insurance company pays?” Yes. That is what she meant. If I wanted to. But I didn’t have to.

People, I ask you: who the fuck would want to do that?

Now might be a good time to remind everyone that this service was performed at the for-profit HCA (now TriStar) hospital in Nashville, Centennial. And I just have to wonder again if this isn’t some kind of scam they’re running trying to get money out of people who are new to dealing with hospital billing departments and insurance, now that ObamaCare has brought thousands of newbies into the system.

It just seems a little sleazy to me. I absolutely would not be surprised to learn that staff at Centennial are given a bonus for every “early payment” they coerce out of patients.

Meanwhile, BlueCross/BlueShield has started sending me a stupid newsletter it calls “Healthy Options,” filled with recipes and coupons for Kellogg’s Frosted Mini-Wheats, Minute Maid Light Lemonade and other crap made out of toxic waste I wouldn’t touch with a ten-foot fork. I don’t know when my health insurance company got into bed with ConAgra, ADM and the rest of our Big Food Overlords but I find this an ominous sign and I’m pretty sure it can’t be good for anyone. I just really don’t want to be marketed to by these people. Seems like there might be something better to do with that money.

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“She Didn’t Ask”

Tennessee Gov. Haslam, who refuses to expand the state’s Medicaid program, preferring to let the state’s poor get sick and die (I suppose), while also claiming to have some kind of super-secret non-existent Tennessee plan that he’s supposedly “negotiating” (wink wink), and who recently was in the news asking HHS Secretary Kathleen Sebelius “to come up with a proposal that would give Tennessee more flexibility to expand Medicaid coverage,” could have asked Sebelius for an update on said plan today. Because today, Secretary Sebelius was in Nashville urging people to sign up for ObamaCare:

Sebelius was joined by Amy Speace, a 46-year-old singer-songwriter who was able to find insurance on the exchange for $30 a month with a $500 deductible, thanks to a tax credit. Speace said she did not at first think she would be eligible for insurance on the exchange because she already was covered by a high deductible plan through a musicians group. Despite that coverage, she nearly had to declare bankruptcy a few years ago when she developed laryngitis and ended up owing $5,000 in medical bills. She was only saved from bankruptcy by the help of a charity.

So, did Gov. Haslam meet with Sebelius for an update on that counterproposal? What do you think?

The governor told a reporter that he had no plans to meet with Sebelius when she came through Nashville on Thursday.

“She didn’t ask,” Haslam said.

I guess he just doesn’t give a shit.

Every day thousands of Tennesseans who lack health insurance face bankruptcy and worse. Gov. Haslam certainly doesn’t seem unduly concerned about those folks.

Good to know.

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Yet Another Anti-Obamacare Story Falls Apart

The Tennessean committed an act of journalism and actually looked into the claims of Emilie Lamb, a Tennessee woman who has become the “national posterchild” for the anti-Obamacare crowd, appearing in Americans For Prosperity ads and mentioned in an op-ed by that harpy Marsha Blackburn.

Like every other one of these stories, it doesn’t add up:

Her beef? The health coverage she had received for years — and liked — under a state program known as CoverTN ended last year because it was deemed substandard under the health care law. Now she pays seven times more for a plan she says is more than she needs.

Supporters of the law who have examined CoverTN say the coverage Lamb had under the state plan was the very kind of junk policy the health care law was meant to replace.

There were restrictions on the number of times she could see a doctor or specialist. Emergency room visits were limited. Financial help for prescriptions was capped. But the real danger of CoverTN, they said, was that it covered a maximum $25,000 in medical bills a year— an amount a moderate hospital stay could easily eat up.

Even BlueCross BlueShield of Tennessee, which administered the program for the state, warned consumers on its website that CoverTN benefits “are very limited compared to traditional insurance.”

[…]

Advocates for the health care law say Lamb was lucky to avoid financial ruin under her old plan, especially because of the long-term expenses associated with lupus.

And they said she could have opted for a much less expensive option that covers hospitalization — including a plan costing $159 per month — among the 37 plans offered on the federal HealthCare.gov health exchange serving Tennessee residents.

Basically, Lamb is an idiot. As I wrote last November,

If you liked insurance that is basically ripping you off then you’re a moron. You’re probably one of those people who thinks a Nigerian prince wants to send you a million bucks. Guess what, that’s a scam, too.

Okay, it’s not fair to say CoverTN was ripping people off but let’s remember who and what it was designed for: it was a program Gov. Bredesen created to cover all of those people who were uninsured because of pre-existing conditions and those who got kicked off TennCare, our state Medicaid program. It was,

[…] designed to offer stripped-down medical coverage to the uninsured at a steep discount.

Denying coverage because of pre-existing conditions is now against the law — remember, this is the part of the Affordable Care Act everybody likes — so you can see how an insurance program designed to cover a group of people who no longer exist might be a tad superfluous.

CoverTN was also created for the unemployed and self-employed — it was designed for portability. Again, this is a key part of the Affordable Care Act (and the part that the media completely missed when it erroneously reported the “Obamacare kills 2.5 million jobs” lie): with health insurance tied to your employment, people didn’t have the freedom to leave jobs, retire, stay home with the kids for a while, start a new enterprise, be self-employed, etc. etc. If you, your spouse or child had a health condition, you were trapped in your job by your need for health insurance. Under Obamacare this is no longer the case. As a self-employed person let me say: this is wonderful.

Also, CoverTN was created for low-income people who made too much money to be eligible for TennCare but not enough money to be able to afford traditional insurance. Emilie Lamb paid $52 a month, but that was just one-third of the actual premium’s cost: the rest was paid by employers ($50) and the state ($50). Seems like if Gov. Haslam would get off his ass and accept the federal help to expand Medicaid here, people like Lamb wouldn’t be complaining.

And finally,

The entire Cover Tennessee plan will “sunset” in 2010, at which time it will be re-evaluated by the legislature.

It was going to go away anyway.

CoverTN was created as a stop-gap measure for a marketplace which no longer exists. People are no longer denied insurance for pre-existing conditions. The unemployed and self-employed no longer have limited options for obtaining health insurance. Low-income people — at least, those in states which don’t have recalcitrant Republican governors who’d rather hurt the poor than defy the Tea Party — have expanded state Medicaid programs to turn to.

I just can’t take Emilie Lamb’s complaints seriously.

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Rand Paul Is Lying

Stop the presses: Rand Paul claims when his son signed up for Obamacare, he was “forced” onto the Kentucky Medicaid rolls:

The senator briefly flashed a blue-and-white insurance card before launching into a diatribe about his son’s travails: “We didn’t try to get him Medicaid…They automatically enrolled him in Medicaid,” Paul said. “For a month they wouldn’t talk to us because they said they weren’t sure he existed. He had to go down to the welfare office, prove his existence, then, next thing we know, we get a Medicaid card.”

Paul then extrapolated from his son’s experience to make a general point about Kentucky’s health exchange: “Most of the people in Kentucky are getting automatically enrolled in Medicaid.”

Paul is lying.

The Affordable Care Act allowed states to automatically add residents who already receive other social services, such as food stamps and other health programs, to the Medicaid rolls. But Kentucky chose not to take advantage of that provision of the law. The state is notifying some residents of their eligibility for Medicaid, but Paul’s son would have needed to actually apply for Medicaid in order to receive a Medicaid card.

Midkiff couldn’t discuss the Paul family’s specific troubles due to confidentiality laws. But her general description of the state’s exchange clearly contradicts Paul’s story. When a Kentuckian visits Kynect, the state’s health insurance website, she’s asked to provide basic information about herself—age, location, income, number of dependents, etc.—to determine whether she qualifies for the Medicaid expansion or other insurance subsidies. The website is designed to encourage people who are eligible for Medicaid to apply, but it doesn’t force anyone onto the Medicaid rolls. The applicant would still have to actively choose to enroll in a specific Medicaid plan.

Rand Paul is lying.

Of course, it wouldn’t be the first time.

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