Health Provider Arrogance

I haven’t bitched about the health care morass for a while, so I should rectumfy that straight away. This is a story of something that happened to me recently. There’ll be some editorial comments at the end.

Back in July, I scheduled some minor sinus surgery, which was to be performed by my ENT guy at a local same-day surgical facility. It is that surgical facility that is the subject of this post; since it won’t mean anything to my mostly out-of-town readers, its name is unimportant.  I’ll save that for my megabitch post on Angie’s List.

The surgery was to take place on July 18. A representative of the surgical facility called me a few days after I scheduled the surgery with my ENT’s scheduling person, asking me to pick a time and date to “pre-register.” For those of you who don’t know what “pre-registration” in advance of a procedure might mean, they want to do some blood tests, read some vital signs, and most importantly, collect an estimated amount that the patient would be required to pay after whatever his or her health insurance pays their coinsurance. Knowing all too well what they were up to, I snickered at the medspeak euphemism “pre-registration.”

Having been to same-day surgical operations before, I had set my sights low regarding what I would encounter on pre-registration day, which was July 12 (far enough in advance to ensure that if my check bounced, they could call off the surgery). I was pleasantly surprised by the aesthetics of the building’s exterior and the spaciousness of the waiting room. My first order of business, of course, was to pay. God forbid they should incur the expense of weighing me and drawing some blood if I hadn’t prepaid! OK, so I sat at the pre-registration window where the nice lady on the other side told me that after consultation with my insurance company, I would have to fork over close to $800 of pre-registration money. Because I was close to my deductible limit, I thought that the amount was probably pretty accurate. If not, I anticipated a timely refund of the excess.

My surgery went well. The medical personnel were great, and the recovery room was large and well attended. I was happy with the service I received there and with the friendly competence of the employees.

Along about the second week in August, I received an Explanation of Benefits from my insurer, which covered the surgery facility charges. They were just under $200, which meant that I was owed approximately $600. I decided to wait for a refund, so I set the issue aside. Alas, being absent-minded (if not feeble minded), I unwittingly ceded control to them and relegated myself to their back burner.

On September 29, I found this thing sitting at the bottom of my “pending” file. I called to ask about my refund. The billing person I spoke with said she would have to call their billing office in Texas to get the “status”. I told her that I didn’t want a status; I wanted a refund. She said that her manager was out, and it would have to be her manager who could give me a better idea of when I might receive a refund. I told her that she could also tell her manager that holding onto my money for this length of time without a show of interest of any kind went so far against my grain as to preclude me from considering using their facility in the future. The powerless clerk empathized with me. We agreed that her manager would call me the next day, which was Friday. As there was nothing else she could do, I bid her au revoir.

I was not surprised that I didn’t hear from the manager on Friday. Medical administrative people think that their customers are insurance companies or government Medicare/Medicaid, and that patients are just incidental to the whole circle of cash flow, pains in the ass who carry the plastic key to the insurance company or government coffers. If they are forecast to owe any money, it must be collected in advance. One might have a FICO credit score of 800 and huge credit limits all over the business world, but only the medical industry has the chutzpah to put creditworthy customers on an automatic C.O.D. basis with no exceptions. So, I would give the manager all day Friday to prove by not calling me, as expected, that I was just a pain in the ass.

I called her on Monday. She told me to wait while she checked on the “status.” (Oy, enough with the status, already. I had been statused to a frazzled, hair-trigger anti-personnel device.) After a couple of minutes, she came back to tell me that the refund had been “processed” (I guess that’s one of the “status” categories) on September 29. Last Thursday. That happened to be the day I spoke to the powerless clerk in the absence of the manager. Was it a coincidence that the refund was processed that same day? I think not. The powerless clerk somehow initiated what she told me she didn’t have power to do. I had apparently made clear my degree of disgruntlement.

I told the manager I would expect the check in the mail in the next day or so, or I would consider doing a charge-back with the credit card company that handled my pre-registration fee. Before I asked her why it took so damn long (almost two months), she told me that the reason was that they were short-staffed and things were prioritized as necessary to deal with the short staff. I told her that my money was priority one, as should any customer’s. After all, if you piss off enough customers in any other business, you won’t be in business long. But the usual rules don’t apply to the medical industry.

“Hell, there’s a recession going on out there with millions of people unemployed and on the street,” I said, “and you’re telling me that you’re short staffed. I’m assuming that it’s by choice that you are.” I reiterated my position that I wouldn’t deal with any outfit with such a cavalier attitude about patient’s money. I told her to pass that on to whoever decides the priorities.

I actually did receive the check in yesterday’s mail. It was indeed postmarked at a Dallas, Texas ZIP code on September 29.

High-deductible health insurance policies and Health Savings Accounts (HSAs) were a step in the right direction, thinks this Turkey. First and foremost, it gives the patient a dog in the fight. If enough people were to participate in this type of shared responsibility, I am convinced that this country would see a reduction in health care costs. People have been used to their employers’ insurance plans paying for most of their medical expenses, so they tend to overuse services. Doctors, undercompensated by government and private insurers who follow Medicare’s lead are gaming the system by prescribing superfluous testing for patients to be performed in facilities they partly own or from whom they receive kickbacks. And patients are pawns who are lucky if they get decent care, because they are significantly outside the revenue loop.

Enter the high-deductible health insurance policy. The patient now participates in a greater share of the costs and is therefore more careful with his or her own money, questioning the need for tests and procedures, and also avoiding providers who treat him or her poorly. It works just like your CPA or your attorney, assuming that you don’t have  accounting or legal insurance. You see these professionals only when there is a clear need for their services. You don’t go to your lawyer every time you need to write a nasty letter to someone. You don’t go to your CPA to balance your checkbook every month. Why, then, should you visit your doctor for each case of the sniffles that will resolve itself in two weeks regardless of what the doc does? Answer: if it’s your $75 for the appointment, you might take some Sudafed and hope for the best.

(I’m referring to non-emergency services here, where you have a choice in the matter. If you’re run over by a bus, under indictment by the IRS, or arrested for drunk driving, you have little choice other than to get the necessary services.)

But instead of the sane and rational scenario I’ve just described, Obamacare (and whatever your Congress has in mind as a follow-on) takes steps to severely limit individual participation in the system. After all, if people are wards of the state, they’ll be beholden to their saviors, which in this case are the Democrats. Never mind that anything government touches winds up tainted by huge administration cost and eventual fraud and abuses, our leader’s solution is to have a panel of cost-oriented bureaucrats deciding what is necessary and what is not. This aggregate, one size fits all approach has been tried in other countries with socialized medicine, and it has created unwelcome compromises by removing the individual patient from the decision process. Eventually, because government funding priorities are largely dictated by other non-discretionary budget items such as the interest on the growing national debt (part of which is related to Obamacare), health care will be put in the squeeze, with more and more medically desirable tests and procedures being disallowed. If we were paying for these things with our own money, our own personal budget would dictate what we could spend.

Which way would you rather have it? One size fits all, where you’re denied a procedure that would improve your life because too many people are going to the doctor to suit the bureaucrats (which they’ll call “waste, fraud, and abuse”) or making that decision yourself, perhaps having to take out a loan or work another job to get what you want? Too many people are buying into the smooth-talking sales pitch of our schlocky president, who never talks about the downside of socialized medicine: namely, that you’re even more of an anonymous lemming than you were before.

But I digress.

I got my refund. I should be happy, right?