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There are times that those of us in the UK complain about NHS waiting lists and so on but Jay's LiveJournal and blog posts bring home to me, more and more, that we are SO lucky to have the NHS!

Originally posted by jaylake at [cancer] A LOT more on that billing problem

The joys of our American for-profit private healthcare finance system continue unalloyed for me. Now I am finally naming names, after having been coy about this up until this point for the sake of professionalism.

Yesterday I received a call from the main billing office at OHSU, the hospital that has been providing me with all my cancer care since day one of this horrible misadventure. I was told that my insurance carrier, UnitedHealthcare, had ruled the 1/7/2013 visit to my oncologist as out of network, and that financial responsibility for the bill was back to me, or I was free to take it up with the insurance company further. I pointed out that I had spoken to both UHC and OHSU repeatedly, and this was a billing mismatch of some kind, probably from OHSU's end. I further pointed out that on the same damned bill they'd just sent me, later visits to my oncologist were correctly billed in-network. The OHSU billing rep was professional but not particular nice about this, reminding me they were giving me a courtesy call. I said the courtesy had gone out of this process a long time ago.

After we got off the phone, I tallied my contact notes on this issue in a spreadsheet. Counting yesterday's calls (including a brief callback from the billing rep), I have placed or received sixteen separate phone calls on this matter, and with transfers spoken to or left voicemails for twenty-five people. (Note that some of those were multiple contacts with the same person, so that's actually eighteen different people.)

So I opened complaints with the Oregon Attorney General's Consumer Protection Division, as well as the Oregon Insurance Division. I also spoke to someone from the Joint Commission, that handles hospital accreditation, but they only review medical practice issues, not business issues. Finally, thanks to help from a friend, I also emailed a state senator who used to be a physician in practice at OHSU.

The email I sent the senator about sums it all up, so I'm reproducing the main body of the message here, with only the greeting redacted:
I am having an intractable problem with OHSU, specifically on the business side of the house. I am a late stage cancer patient, incurable, transitioning to terminal status. I have been seeing my oncologist at OHSU since 2009. I have had five major surgeries and over 1,500 hours of chemotherapy, all of that except the first of the surgeries under their care. On my 1/7/2013 office visit, my insurance company, UnitedHealthcare (UHC), classified my oncologist as out of network, despite their having always been in network. This resulted in much higher billing fees to me, $283.59 instead of my $40 office visit co-pay.

After multiple phone calls, I determined that OHSU had changed my oncologist’s billing address. This created a data mismatch between the hospital's billed zip code and the insurance company's in-network provider database.

In the three months since, I have spoken or left voicemail for 25 people across 16 phone calls to both OHSU and UHC. They are completely unable to resolve this billing data mismatch, even though both prior and subsequent visits to my oncologist have been correctly billed as in-network. I was told this morning (4/22) by OHSU that it was an insurance company problem and they could not resolve it. I have been told repeatedly by UHC that this is a billing problem and they cannot resolve it.

I cannot fix this. I have no power over OHSU billing process or UHC’s claims process. In the last months of my life, I am spending many hours on the telephone pursuing this matter which apparently cannot be resolved from either end, resulting in me being held responsible for out of network charges.

While the amount in question is small, and I am by no means destitute, I should not have to pay this. I am covered by an employer sponsored plan, my oncologist is in network on my insurance policy; that should be the end of it. And the process has frustrated me sufficiently to make me want to continue to maintain the principled stance I have already taken.

As of today, I have opened complaints with the Oregon attorney general’s consumer protection division, and the Oregon insurance division. I’m not sure either of these is going to have any effect. I was hoping you might be able to direct me to a suitable path of management escalation within the OHSU organization, either in your capacity as a physician who has practiced there, or in your capacity as a state senator.

I can provide call logs documenting every conversation with OHSU, along with billing records from OHSU and claims management documents from UHC, as needed.

Thank you.

The basic problem is, of course, no one in authority at either OHSU or UHC has any particular motivation to fix this. The problem just goes around in circles at low levels and keeps getting referred back to me.

This is precisely what is wrong with our current healthcare finance system. The Affordable Care Act (Obamacare) only does a very partial job of fixing these kinds of problems. Civilized, humane societies with single payer systems don't create this kind of hassle and heartbreak for their sick and dying. I'm a pretty articulate guy with good social and professional resources, and this is a small piece of billing. Imagine my position if the billing were substantial, one of my $100,000 surgeries, or if I were confused and baffled by paperwork and unable to untangle the repeat billing trails.

This is wrong. I wish the conservatives in this country who have opposed the process of healthcare reform were capable of the kind of empathy and understanding that lets them see past their ideological blinders to the hard reality of the system they so blithely support. And I fervently hope for their sakes that they never have to go through what I am going through. Self-evidently, their suffering means a great deal more to me than mine means to them.



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