4/11/2018

In case you weren't keeping up at home, healthcare is still broken.

In January, eldest boy was goofing around (as boys do) one evening, spinning on his knee in the living room. He lost control and wham ran headfirst into one of the ottomans of our poang chairs (those are the cool chairs from Ikea.)

There were many tears and great drama, all of which I immediately discounted because, on any given day, if the younger boy looks at the older boy wrong, there are tears and great drama and so I've slowly become immune to cries of, "Owwww! It hurrrrts!" Because most of the time, no, it doesn't, because frowning at you from across the room can not actually cause injury.

This time, however, he continued and then cried, "I'm bleeeeding!"

So okay, let's see what we got.

I look and go to the closet for my shoes.

"Get your shoes, you need stitches."

More wailing, now intensified because hello? Now he knows he's injured so it absolutely hurts more.

So with hubs minding the fort at home, oldest and I hurried off to the ER, and I thought to myself, "Well, at least we're at home this time so we're not heading to an out of network hospital." (Because two-ish years ago, we needed an x-ray when away from home and that bill was unpleasant to say the least.)

Fast forward to this week, when I get a call letting me know that we're being balance billed for the doctor who did the stitches while at the ER.

"But wait," says I, "we went to the local hospital. It's clearly stated that's in network."

"Oh, yes, but the doctor is out of network."

"How," gritting my teeth and trying not to yell, "I wonder does that work? If the hospital is in network, then aren't the health care providers employed by same also in network?"

Short answer? No.

Apparently, ER docs, anesthesiologists, pathologists, and one or two other ologists aren't required to be in network even when employed by an entity that is. So the insurance company lady said that basically they have a new process. They pay as if they're in network, and, if someone squawks, reprocess as out of network.

Why?

Why can we not simply charge what things cost and then pay the same? Why are there kickbacks and special deals in the back room that allow one insurance to pay X when others pay Y and the consumer paying direct pays Z? It drives me absolutely up a wall.

Best part of this whole fiasco? Helpful insurance lady says that usually in cases like ours what ends up having to happen is they write us a check and then we have to wait until we get billed and then pay the balance ourselves directly, because reprocessed claims can't be done any other way.

Broken. The system is ridiculously broken. (and let me just be clear that getting the government more involved in this madness is only going to break it more, not fix it.)

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