Navigating the System

I posted yesterday about my frustrations with insurance.  Well I spent today on the phone getting the runaround from each and every office I spoke with (though the individuals all meant well).  At the end of a very frustrating experience I came to the conclusion that I am getting worked by the system despite my best efforts and just have to suck it up and write a check.  Gratefully I have an out of pocket maximum for the year and will meet it (actually exceed it) with one bill (plus all the payments I have made to date).  So I will pay that singular bill and send the rest back to my insurance company.

What kills me is how this business is set up.  For example, as a part of my initial diagnostics I was sent for a Pet scan.  They sent me to Novato Community Hospital for this scan, with no discussion of other places I might be able to go.  I was clear that I had a flat copayment for this service.  What I didn't know was that by virtue of the fact that I went to NCH for this test, I was treated as an outpatient for a procedure, which has a 20% copayment.  In this case, that copayment turns out to be 5 times the cost of the expected flat copay.  Although again it isn't about the money because I am going to hit that maximum regardless, I was flabbergasted that no one bothered to notice this for me, or warn me or give me any sort of a choice.  I know there are standalone radiology units where this wouldn't have been the case.  I don't so much blame my doctors office who referred me for being malicious, simply not aware of the difference or too overwhelmed to even think about it.

But this experience takes me back to what I said yesterday- who is looking out for the patients?  Here we are facing life-threatening illnesses.  Doing whatever it takes to save our lives, and getting screwed from every angle in the medical billing world.  How can we be expected to know our own policies well enough to be able to advocate for ourselves that we will not go to a local hospital for a scan because it will be billed differently than if we went somewhere else?  It would never have even occurred to me.  I did take the time to review my policy and familiarize myself with what the costs would be associated with each and every treatment and exam I expected to have.  But I absolutely could have had no way to know that things would be billed differently than one would logically figure they would be billed.  Between the location of my Pet Scan and the coding of my post-chemo shots, there was absolutely no way that I could have planned for or avoided these costs.

Maybe this will be my calling, putting together a non-profit that offers financial and billing advocacy.  At the time of diagnosis (assuming patients are referred to us as soon as possible) we would familiarize ourselves with their policies, and work to protect them from what feels like a predatory industry.  Too bad I really dislike this stuff personally.  Anyone love numbers and accounting and policies and want to help me get this service started?

The sad thing is that I think I am one of the lucky ones with decently good insurance coverage and the capacity to pay attention and advocate on my own behalf.  I just keep thinking about those who are worse off and still fighting for their lives.  It just breaks my heart.