Sometimes people are magically teleported outside of their health care silo.
This happened to a group of our participants every month for several consecutive months.
At the beginning of each month one of the members of this group would call our office – “The doctor won’t treat me because he/she was told I have no health insurance.”
Our Plan had recently approved coverage for domestic partners. Somehow, the computer system of one of our carriers could not properly interpret the code for a domestic partner. The computer saw this adult as a child. Continue reading ‘Administrative Simplification’
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Seven dollars and forty cents hardly seems like an amount that should erect a barrier to health care.
In fact, when Mr. Koch (all names are fictitious) called to complain about this bill for seven dollars and forty cents, my first reaction was, “You should appreciate how lucky you are that you have a health care plan that pays most of your bills. Why are you quibbling over $7.40?”
Of course, that is not an appropriate customer service response.
But listen to Mr. Koch. “This bill is for two pain pills that were given to me when I was admitted to the hospital for an emergency surgery. Medicare won’t pay for the pills because they were “self-administered.” Continue reading ‘Seven dollars and forty cents – no sense’
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Approximately six months ago our office began receiving stacks of paper claims for prescription drugs. The drugs originated in various Veterans’ Administration medical centers around the country. They were for drugs that members in our Plan had received at VA medical centers.
It was obvious that there had been some sort of new policy at the VA that required the VA to obtain payment from other payers when veterans had other coverage. The problem in this case is that our Plan had just changed pharmacy benefit managers effective January 1, 2008.
So think about this. Continue reading ‘A game of Old Maids’
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Amazing seems a most appropriate word to describe the financing and delivery of health care services in the United States of America.
According to Merriam-Webster’s Collegiate Dictionary, 9th Edition (OK, I have an old dictionary) amazing is derived from a French word meaning “to confuse”. Obsolete meanings include consternation, bewilderment and perplexing.
Yes, health care in the US is truly amazing. Rube Goldberg could not have invented a more illogical maze of non-systems. Lewis Carroll’s might have added an additional chapter on Alice’s efforts to get those pills that made her big and small. Kafka might imagine a special Penal Colony for those responsible for this maze.
I should be careful on this last point, since I am part of that system. Continue reading ‘The Amazing US Health Care System’
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