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My guest today is Lynn Petrovich, a CPA and long-time advocate for universal health care. Welcome to OpEdNews, Lynn. You recently wrote an op ed piece about your own adventures in the health care system, "Hospital Accounting: It's Complicated." Up until a family member's unscheduled visit to a local emergency room, you had assiduously avoided the health care system, although you do have health insurance. Why is that?
Joan, the for-profit health insurance industry has set up so many road blocks to payment for health services that it makes even those who have health insurance skittish about using the system.
About two decades ago, one Saturday afternoon,I came home from shopping and, noticing my husband's car not in the driveway,walked through our front door to see a blood trail leading from the back room to the kitchen to the refrigerator to the freezer to the bathroom to the phone to the back door,down the steps and ending where his car would have been parked. It was apparent something terrible had happened. I was in a panic.
He had been working around the house and severely cut his hand using a hatchet. Despite the loss of blood and in severe pain, he was able to wrap his hand in ice and towels and drive himself to the emergency room...about a 10-minute ride.
The wound was deep enough to require extensive stitching from a surgeon, bandaging,and subsequent rehabilitation. He was lucky.
When the claim was processed by our insurance company, it was denied for the following reason:His injury was not considered an emergency.
The health insurance industry has finely tuned health "providing"into a set of definitions and procedures that are absolutely cumbersome, contradictory, and outright ridiculous. I've talked to many people who just give up and end up paying the bill out of pocket.
Over the next 15 years, when my daughter played sports throughout her school years,the insurance company's madness intensified. The paperwork was enormous...and oftentimes hilarious. After one injury she incurred during a basketball game, the seven-page "Required Compensation Claim Damages" form received from the insurance company after her visit to the doctor asked, "What was the patient doing prior to be injured?" I responded, "Sitting on the bench waiting to go in the game."Here's another question: "What was the patient doing during the injury?" I responded, "Setting a screen so her teammate could drive to the basket."
It often took three or four "appeals" to get the payment processed.
Five years ago, my husband had hernia surgery in a
day-stay operation at our local hospital. The insurance company -
Interstate Compensation Blue Cross and Blue Shield of New Jersey and
Pennsylvania (which I nicknamed ICBS) refused to pay the hospital for the
operating room. I fought them for four months. No payment.
Finally it went to collection.
It would have been much easier for my husband not to have had the surgery. I mean he would have gotten some funny looks at the 7-11 and the movies what with his intestines hanging out and all...but it would have been much easier than going through all this nonsense with the insurance.
The operating room invoice ($900 for 1 and a half hours) after nine months finally was paid by insurance. But the damage was done. Our credit reflected an account in collection.
What a horror story. Now, I understand why you avoid the health insurance system like the plague! And I've heard that, in the majority of the bankruptcies caused by medical issues, most of those individuals had health insurance. Can that be true? If it is, we're all truly one medical "incident" away from catastrophe.
Yes, if you think about it, the majority of
American citizens are basically one incident away from becoming
insolvent. We work The American Dream, buying a home, saving for our
children's colleges, building up equity in our homes, trying to save and plan
for the future only to be faced with enormous medical bills should a loved one
become sick, injured, or chronically ill. Many hospitals require tens of
thousands of dollars up front prior to cancer treatments (and that's if your
insurance company hasn't denied the treatment).
I prepare many tax returns for senior citizens. In fact I'd say the majority of my clients are over 65.I always ask them about medical bills which many new clients don't seem to think is important. After I walk them through the process, that is, asking them:Did you have any dental work? How about doctor appointments? Lab work? Prescription drugs? Co Pays? Deductibles?Medicare B (which is shown on their SS statements and additional insurance (which many have through AARP)? Don't forget you can deduct mileage for treatment to doctors and hospitals.
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