Invoking the spirit of Michael Moore

OK, I know he's not dead, but it's still in the spirit of Mr. Moore that I write this post.

I hate health insurance. Don't get me wrong--even crappy insurance has value, but it seems like insurance companies go out of their way to confuse the very people who are paying hard-earned money to keep them in business. Maybe I just have more than my fair share of trouble in this area. It's not a good combination with low frustration tolerance. Glaaaaaa.

Because I have had terrible problems with health insurance in the past, I've learned to be careful and deliberate in looking over my statements and medical bills and reconciling all of them. I suggest you do the same. Part of this diligence comes from my tendency to get muddled and frustrated when I'm not feeling well. Part of it comes from three years ago when we had to change insurance companies three times in 12 months through no decision on our part--and each change brought a new deductible. I paid close to $10,000 in out-of-pocket for my medical care that year--my first year trying to actually treat BP instead of pretending I didn't have it.

In 2001, I had surgery on my right knee. Before I could have surgery, though, I needed to undergo ten weeks of physical therapy three times a week (cha-ching!). The surgery went well, but I still needed more physical therapy afterward. The bills started coming in and I found them almost impossible to decipher. It was beyond frustrating.

I ended up making a massive spreadsheet to reconcile the appointments, the bills, the insurance payments, and my co-pay. Unfortunately, the insurance company wasn't so organized. They started sending me duplicate bills, bills for procedures I didn't have done (like wrist surgery), and bills for difference between the regular bill and the student discount I was receiving as a graduate student.

For almost nine months, I cried, I lost sleep, I had maddening conversations with ignorant people at a call center somewhere in California. Nobody would look at my hard copy bills; instead, they would only refer to what was on their computer screen, which happened to be wrong and quite different from what was on the paper they had sent me. I accidentally overpaid one bill by $50 and the company just flat-out refused to return the money. I finally contacted one of the local TV consumer news reporters and once he contacted the insurance company, *poof!* I got my $50 back and all nonsensical billing ceased.

Ever since the knee surgery incident, I have been careful--very careful--to keep track of my medical bills and insurance claims. It doesn't matter. My insurance company, Great West, has been pretty good for the most part, although they, too have chronic billing problems as well as a severely disfunctional IT department. This plan year went a lot smoother than any other I've had. I almost exhaled, but then I got The Letter. Dear Ms. Voirrey, an internal audit has revealed an error in your account. Numerous claims were not applied to your deductible and this has resulted in a need to adjust your deductible. Great West will resubmit these claims. This will, unfortunately, result in a financial liability for you as you will be required to pay the difference to your service providers. Blah, blah, blah, we screwed up royally and now we're sending every single one of your bills through at 100% patient liability, and only you can figure it out because we can't add or subtract, not that we care. You're the one who has to write the checks.

This is a sizable error, or so they tell me. That isn't the scary part. The scary part is that Great West has completely stopped paying anything on any of my bills, and all of the new bills I've incurred for the last, say, two-and-a-half months, are coming directly to me, payable in full, no discount, no deductible. I have to pay the bills up front and hope I get my money back later. Nobody believes a thing I say, even though my canceled checks show I have paid hundreds of dollars in excess of the deductible. My argument falls on deaf ears, and nobody wants to see my documentation. Apparently, I know nothing and am not to be trusted because I am merely a customer/patient.

This has certainly whipped my mood down into submission. I feel somewhat defeated. I don't think I can fight another insurance fight. I asked a supervisor at Great West what went wrong. Here is the response, which I have cut and pasted from the secure email that was sent to me:

Thank you for your recent e-mail inquiry. Dana has informed me that she contacted you today updating you with the status of your claim history. We can send you a copy of the spreadsheet that was completed with a breakdown of the claims.
You brought a system error to our attention, I am sorry we can not explain a situation with our system when we don't understand what happened. I do apologize that this has been an incredibly difficult situation for you. We want you to understand the claims should have applied the deductible at the time the claims originally processed.
The providers involved will usually work to create payment arrangements that will work for you. We don't want you to cancel any medical services for conditions that are causing you pain, hopefully information below will help explain your plan further.

(At which point he proceeds to tell me what my insurance deductible and co-pay are. Very insightful.)

I hate insurance companies. Why can't they seem to get their billing right?