Tuesday, November 27, 2007

Healthcare in this country is crazy

I only have a couple minutes before my next thing to do, but I needed to post this story before I forget it.

I've always thought the whole healthcare industry in this country is completely insane. I've always had insurance, luckily, but any kind of interaction with the healthcare system has always left me confused/angry. And the way I figure it, I'm a reasonably intelligent person who only has to worry about himself...how much worse must it be for senior citizens, or people with tons of family obligations that leave them with even less free time than I have?

So what incident got me thinking about this stuff again? I went home for Thanksgiving this past week (which was good btw) and found I had a couple letters from Aetna. I had Aetna coverage as part of both of my pre-B-School jobs, and now here in Chicago.

So I open these letters, and each of them have information regarding healthcare claims made on my policy. These claims were processed a couple weeks ago, but the dates of service were in November and December of 2006, respectively.

The items they listed looked relatively standard, a US exam on one, and a series of normal blood tests on the other. The provider was listed as some fund in California, which seemed odd. Then there was the part where they said I owed them over $1200 for those services, because they were both out-of-network and because my coverage had been terminated before the services were rendered.


I fixated on the $1200 part, not even really thinking about the California element. I was livid, convinced Aetna was actively trying to go out of its way to screw me over. I've never had an insurance company make a mistake that accidently gave me more money than I deserved.

Anyway...since it was Thanksgiving, they weren't open to receive customer calls. They weren't open on Friday, or over the weekend either.

OK, so I got back to Chicago on Sunday night, and called them first thing on Monday.

The first Aetna rep I spoke with didn't quite understand what I was saying. I tried to tell him I hadn't been to a doctor for bloodwork in that time, but he didn't seem convinced. He suggested I call up my doctor's office and see what the deal was. Fine, so I called my most recent doctor and asked what the deal was with this extra $1200 in charges. They had no idea what I was talking about, because as far as they were concerned, everything was taken care of and no one owed anyone anything.

Hmmm.....let's try Aetna again...

New representative this time, maybe she would be more helpful. And this time, I was armed with some advice from the receptionist at my old doctor, who said, 'That sucks for you, make sure you document exactly who you speak to and what they say and get confirmation for everything, because they'll try and screw you.'

Good words from a healthcare industry professional.

So I'm talking to the Aetna rep, and I tell her that I'm confused, because I don't recognize the provider or the services.

She goes to get more information on the claims.

"It's for a Dr. Chien in California." she said.

"I've never even BEEN to California!" I said, which is a bit of an stretch, but realistically, I've never seen a freaking doctor in California.

"Can you get more information on the actual procedures?" I asked

"Sure, please hold" she said

I waited for a while, then she came back on the line.

"The first one was an ultrasound and a uterus exam"

Needless to say...I felt as though someone at Aetna should've been a little more on the ball before billing me for this stuff. Like maybe just looking at the file and noticing....'hey, this is a guy, he probably isn't having any ultrasounds done on him'

So with my gender as proof, the Aetna rep agreed to void the claim and work back to see who actually received the services. It didn't help that the doctor's phone line was disconnected (shocking, for someone who clearly doesn't run an efficient operation).

But they've assured me they'll take care of it....we'll see

No comments: