Category: Medicine

About a week ago I wrote a post detailing my family transition from a company subsidized health care plan to bearing the full cost of the plan under COBRA.

I’m astonished to report that the bureaucratic ineptness and bungling continues. As of yesterday, having invested just under $3,000 of my own money I find myself… still without any kind of coverage whatsoever. Effectively, we have been without any medical coverage since the beginning of November and that doesn’t look like it’s going to change any time soon. Were I to visit a physician’s office, the pharmacy, the dentist or the Emergency room all will tell me that, according to Aetna I have no medical coverage at all.

Of course some day all this will likely be reconciled but that does not eliminate the possibility of financial ruin and rejection of medical care due to lack of insurance. My credit card limits are sizable but it is doubtful that even they could handle more than a couple of days in any hospital.

The added twist comes with the new year when my new insurance company is introduced (my former company is switching from Aetna to Cigna). Who knows how it will play out when one of us visits a pharmacy or medical clinic in the next month or so?

Sadly, it appears that your best bet is… well… there doesn’t appear to be one.

The COBRA system was likely conceived in good faith by beltway individuals who may understand theories of economics but have assistants and enough notoriety that they remain effectively shielded from the “normal” experience of dealing with the systems that evolve to administer such legislation. It’s long been my opinion that things only get fixed when those responsible for them must endure them directly. This does not happen with health care and legislators, doctors or anybody with a say in how such things run.

By now most of you who know me know that I changed jobs at the beginning of November. As of this posting I still don’t *have* medical coverage although I apparently *am* covered.

COBRA is an option that exists for folks who wish to protect themselves from America’s disastrous health costs by maintaining their former employer’s insurance for up to 18 months. Supposedly the only catch is that you must also shoulder your employer’s share of the premiums in addition to your own plus a 1% administration fee. Of course that doesn’t include poor implementation and incompetence on a massive scale.

For my situation probably my biggest avoidable error is that my last day of work was on the 29th of  October. For my company at least, your health care coverage ends at the end of the month in which you terminate your employment. Knowing this, I would have set that last day as November 1st. Not only would I have saved myself an entire month of premiums but some of the delays I’m seeing would have been mitigated.

So, according to COBRA, your medical coverage is guaranteed to continue – in theory at least – for some time after you end your employment to allow you to get through the paperwork and get everybody on the same page. That’s supposedly where Ceridian comes in. Part of their mandate appears to be to not only muddy the waters but also to ensure that it takes as long as possible for your payments to reach your insurer.

A wrinkle in my situation is that, come January, my company will have a new health care provider – Cigna – and so, therefore, will I.

A few days after I left my job I received a packet in the mail indicating that I can expect a package to arrive from Ceridian two or three weeks after my last day at work. I was VERY busy with the new position so I did not chomp at that bit, assuming that this sort of thing goes on for thousands of people every day, companies that specialize in it would have a clue.

So the package *did* arrive about 3 weeks later. It told me that my insurance rates would go up from about $300 a month to about $977 per month – which was actually somewhat better than I was expecting. I just needed to make my elections on the Ceridian web site.

In the process of making those elections (health care for me only or for the family? dental coverage too? etc.). They then indicated that I needed to set up bill pay between my bank and Ceridian and wait for my first bill. Apparently paying right away is a bad thing.

So I waited for a few days for the first bill until Michelle told me that her doctor’s office had called to indicate that Aetna had declined coverage for her recent office visit. OK, I guess that means they *really* want the money in their hands before they’ll agree that you’re covered. So I went onto Ceridian’s site to see if there was a contact number I could use to help sort this out. After logging in I see, *surprise* there’s a bill waiting there for me. Apparently this is not the sort of thing they’d think to send out some kind of notification about.

Good enough, let’s pay that bill and get our ducks back in a row. But hang on a minute. *now* the web site is telling me that not only do they not do the bill pay thing, they don’t even do credit cards or any other form of convenient payment. It’s got to be some kind of check or money order. hmmmm…

So, I send off a check which apparently takes about 7 days to arrive and get cashed. Allowing a few days for them to get the payment and notifications to Aetna, Michelle contacts her doctor’s office who inform her that it’s still a no go insurance-wise. They are sympathetic, apparently this is not unusual.

So Michelle calls Ceridian, Aetna and my old comany’s HR department in turn to find out that:

1) Ceridian is aboslutely certain that the money should go to and did go to Cigna, what is this calendar thing you speak of?

2) Aetna may be sympathetic, but no info from Ceridian (and especially no cash) equals no insurance benefits.

3) Huh?

So, after Michelle has presumably clarified the situation with the people whose job it is to do this efficiently every day, we’re told to give it 2-4 more days.

I’ve been delaying picking up some allergy medication while all this is going on just to avoid tossing more fuel in the dying fire of American health care insurance, but today I called up my pharmacy to renew the prescription and *surprise* Aetna is still refusing to pay.

This is now December 23rd. My check for 2 months worth of alleged health coverage, to the tune of $1,954 has yielded me exactly … nothing. Well… maybe I may eventually be able to claim contiguous coverage, but if I fell down a flight of stairs at this moment, it would no doubt cripple me financially while this fiasco works itself out.

One tiny bright spot in all this. I contacted Aetna regarding my FSA (Flexible Spending Account) and, the way mine is configured it remains valid for the amount that I specified until the end of the year regardless of my contributions.

This means that, having specified an FSA of $2,000 this year and contributing about $1,630 they will still cover the remaining $370 for me. Just a generous perk from my company for which I will offer them kudos. I actually called about it because I was inspecting my balance and saw the mismatch between the money I’d paid so far and the $1,890 in charges they’d covered so far.

So the lesson here (for me at least) is:

a) quit as near to the beginning of the month as possible,

b) quit as early in the year as possible,

c) Contact HR constantly after you’ve given your notice until they can tell you that they’ve notified Ceridian,

d) get registered on Ceridian’s web site a.s.a.p. (all the info was there, I didn’t need the paper package) and register,

e) visit the site daily after that to pick up the bill and send your check a.s.a.p.

f) start contacting Ceridian about a week after you’ve sent them the check (or sooner if you can see they’ve cashed it via your online banking system) and verify that they know who should be getting the money and when they’ll get it

g) about two days after that start contacting BOTH Ceridian and your insurance provider to verify that payment has been received.

I really don’t know if I’m going to have to keep on Ceridian for every month’s payment – I tend to pay my bills as soon as I get them so I *shouldn’t* risk any lapses. But I’m not the only player here.

Why I can’t simply pay my insurance company myself I don’t know. This is equivalent to those crazy escrow accounts for your property taxes. The bank has your money and has to pay the bill, but *you’re* the one on the hook for it and have to chase everybody around to ensure they do their job. I got out of that racket as quickly as I could after buying my house.

I’ve said it before and, tragically, I’m sure I’ll be saying it for many years to come. I *love* living in America – but the thing I am absolutely most terrified of is getting sick or injured here. I’m sure the quality of care will be excellent but I am scared witless that it would come at the price of every last penny of savings and every ounce of credit I would be able to acquire.

That ain’t right.

So, is this a common story? I imagine it only affects folks who have moved into a contracting position such as myself or those who have been laid off work and are not moving into a position where their benefits will be provided again.

For those that don’t know, I hail originally from Canada. There is a lot about America that attracts me and “Government staying out of my affairs” is a biggie. It is with no surprise then that I was very much in favor of shucking off a socialized medical system and its shortcomings for a more pay as you go system.

When I arrived here I was healthy and did not have kids so my contact with the medical system was minimal. Pretty much limited to a general physical now and then.

As I live here longer, I’m starting to grow more and more fearful of the financial repercussions of even a modest illness and find myself hesitant to take advantage of what is arguably one of the best medical systems in the world.

I’ve had a couple of procedures done over the past half decade or so and found myself annoyed that it is very difficult to get a cost for a procedure. They seem easily able to give you a bill before you go into the operating theater but try to get that bill amount when you are setting the appointment and people seem confused. On top of the, rather substantial, bill that you pay up front. The little bills that keep floating in weeks or months later are unexpected and annoying. When you call about them you will find that they are “usual and customary” but that is only for folks in the billing departments of hospitals or in insurance departments.

If I went to a mechanic and had my transmission replaced you can be sure that I am going to get an estimate from him. That estimate better be what I’m charged at the end unless something unusual comes up and, if it’s substantial, I expect a further call to ensure that I want the extra work done (maybe they notice a broken support for the engine while they’ve got the car up on the lift). You can be damn sure I’m not going to be receiving a bill from the “Oil Support Technician” or “Hydraulic Lift Specialist” two months after the fact because they consider it “Usual and Customary”.

In medicine it seems perfectly OK to have essential folks’ services completely omitted from any estimates. I had a hernia operation about 6 years ago and the anesthetist’s (or anesthesiologist’s – can never keep those two straight)  services, something that I consider quite essential when I’m to be rendered unconscious for surgery, were charged for separately at least a month after the fact. I had to call to see if this was legit or some kind of scam because I was so amazed at this boldness.

I need to have an MRI to sort out some issues left over from my bicycle accident a few months back. On Friday my doctor tells me he’ll begin a precertification for this. Today I receive a call from the MRI place to schedule an appointment. I went ahead and set up a date and decided to persue this to see if it’s possible to determine one’s liability and maybe plan for this kind of thing.

The girl on the phone for scheduling, of course, can do nothing for me to help nail down the cost of this thing. So I contact my insurance company. After 15 minutes waiting on the phone I find out that my insurance company contracts out radiology type stuff to a 3rd party precertification company. I’m told I need to call back if I want to find out more about costs because their department also doesn’t handle that.

So I call the insurance company back. We’ll leave the sorry-ass IVR system out of this conversation suffice it to say that it aided me not at all in getting to a customer service rep. All the rep is able to tell me is that I’ll have a $500 deductible and then I’m responsible for 20% of the cost beyond that. OK, that’s in my benefits plan. How much does this kind of procedure cost?  All he is able to tell me is that it will be a negotiated amount and that my liability will be as he’s already said.

So I contact the third party pre-cert group and find that my doctor’s office hasn’t yet initiated the precertification process with them and that my plan is the kind where only a doctor or the MRI folks can initiate the process. But that this process typically takes one business day, so my appointment (scheduled for next week) is not yet in jeopardy.

So I contact my doctors office to see what needs to be done, they acknowledge that they need to initiate this and that they’ll call me back.They call back within the hour and it turns out that this is the normal way that things are done since the pre-cert company likes to know where and when the procedure will occur. So I’ve jumped the gun on this part but they tell me that everything is now in place.

Finally I call the billing department of the MRI folks. It took them 10 minutes to figure out how much this was going to cost me. When I asked if this was an all inclusive price, explicitly mentioning that there’ll be someone administering an IV they did agree that I can expect another, separate bill from them that should only be in the range of “a hundred or so dollars”.

So, an MRI of my head, both with contrast and without will cost me no less than $868. With a little math that puts the “negotiated cost” at $2,340. Then I can expect at least another $100 bill to come floating in sometime after that for the IV person and I have no idea how many other folks it is “usual and customary” to have wander into the room while the procedure is under way and then send me a bill.

The care we have available might be some of the best in the world, but the cost for that care is terrifying – for its magnitude certainly but more so for its quixotic cost. For all its pitfalls, under a socialized medical scheme for all but the most catastrophic of issues my liability is capped so I do not have to put my self or my family at financial risk – heck it’s not even a risk because you cannot even begin to forecast the costs before you begin it’s really more of a game of chance than anything that can be calculated.

So color me leaning back in favor of the socialized medicine side of the debate.  If we can get to a system where I can get off the phone with an appointment and a guaranteed estimate (representing the cost both with and without insurance) and none of those “gotchas” that make this such a risk I will rethink this. Hell I can do it for my car, my cat and my washing machine. Surely we’ve got enough knowledge and experience to estimate simple procedures accurately by now.