Posted by: guinness222 | April 12, 2006

Are you insurance companies totally daft?

This will be short simply because I am still seeing red, but as I explore this I wanted you to share the “joy” with me.
A few weeks ago I wrote about my having to go get the “stress test”, per my Doc at my annual physical, “Just as a precaution and to give us a baseline for the future as you get older. It’s always good to have the baseline as it allows us to notice any irregularities faster.” OK so I go do it, see my blogs about a month ago for the gory details.
Well today when I got home the “EOB” or explanation of benefits form arrived by mail. Sit down you’ll really need to after this!
The hospital bill alone, for the use of the ekg machine, the nurse to hook me up, the paper for the charts, the crap they shot me up with to “light me up” so they could take thier “nuclear pictures” after the treadmill, the follow up two days later to get “lit up” agian and see “resting” heart nuke pictures, a TOTAL of no more than 90 minutes in the hosptial as an outpatient for a “test”,…..the “bill” $10,468.75 !!!
Now let’s see how the great American healthcare scam works. The hospital submits the bill for the $10, 468.75, then the insurance carrier has a “Not covered/Discount” amount of $3,140.62 that they apply, leaving an “Amount Covered” of $7,328.13! With me so far? At this point it would appear the $10,000 is a bogus number, and when adjusted by the insurance carrier by over $3,000 reaches a more palletable $7,000 that’s “covered” by the insurance company,…good, end of rip off sequence. NOT!! The innocuous “Patient Deductible/Co-Pay column is next, but we luck out, that shows all Zero’s, (alas there is a God!) However we next move to a column labled “Percent” showing various figures ranging from “90” to “100”, good not affecting me (I think!), then the final column which is “Plan Liability”(?) . Excuse me, maybe I’m just dumb as a stump, but what the hell’s the difference between the colum named “Amount Covered” and the “Plan Liability”? Beats the shit out of me! Well that column shows a total of $6,797.04. Well “duh!!!” now I undrstand where you came up with the stupid number on the front page of “Total Patient Responsibility: $531.09”
Are you as confused as I am at this point? But wait, there is another column labeled “See Note” all lines noted with an “A”,… oh there it is in fine print at the bottom of the page “A) – Thank you for using the ***** Healthcare Open Access Plus Network (? what the hell is that?) This represents your savings, so you are not required to pay this amount. The Provider is prohibited from billing the patients for the difference. If you have already paid the full amount please request a reimbursement form your provider.”
What the hell is that saying, I owe someone $500+, but because they are on some program I don’t owe them and they can’t bill me and if I was dumb enough to have already paid them, well they owe me?
Looks like we’ll be making “healthcare forms and bills” a new mandatory course for our 8th graders soon so my grandkids can read my friggin’ medical bills and see who I really owe what to and who owes me what, and who I can really give a shit about,…..or not!


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