In Which Our Author Becomes A Deadbeat

suzwe

“This,” the voicemail barks, “IS AN ATTEMPT TO COLLECT A DEBT.” It’s perhaps the third call like this I’ve gotten this week. And my mailbox is filling with threatening-looking letters from nebulously-named corporations threatening all sorts of punishments for failure to pay. Two days ago, I got a “pre-approval” for a secured credit card in the mail — a sure sign that my beacon score has fallen off the end of a very high cliff.

But how did this happen?

Long-time readers of this site might remember that I contracted pneumonia in July. After a brief hospitalization, I was released and given a few different kinds of antibiotics, some of which made me dig my fingers into my skin until blood welled up around them and some of which didn’t work at all. Eventually I was able to go back to work. I’ve had various flight-and-altitude-and-travel-related relapses since then but I’d say I am now at 90% of where I was prior to the hospital stay.

I have the best health insurance my day job offers, plus I signed up for the HSA and the medical savings card. About 15 days after I got out of the hospital, I started getting a flood of mail related to the incident. I received a note from the insurer that of the $13,200 or so of initial charges, they had paid $6,000 and negotiated away $5,000 and the rest needed to be paid to the hospital immediately. So I spent four hours teaching my HSA to pay the hospital. That covered $1400 of the $2100 so that left me with $700 or so to pay. No problem, I have a medical savings card as well.

Except that I got a letter from the medical savings card people telling me that they didn’t recognize the place I’d used it at as a medical facility and had suspended the card. The place in question was a doctor’s office. It has the fucking couplet of letters, “MD”, right in the name cited in the letter. I need paper receipts. But the paper receipts aren’t available at the doctors office. They’re available at an office building downtown. After I get them, I can start the process to un-suspend my medical card and pay my remaining hospital bill. The only way I can contest the issue with my medical card provider is to fax them documentation. There is literally no phone number available.

Meanwhile, additional bills started arriving. I estimate that there were perhaps eight of them, or more, assuming I threw some away as junk mail before I began to recognize the type. Mid-Ohio Emergency Services. (Who are these people? I didn’t take an ambulance to the hospital.) Five different doctors, only one of which has a name I recognize. Two extremely vaguely named medical-sounding places. All billing me between $150 and $900. The bills vary in every particular except one: an all-italic-caps sentence on the bill that says

YOUR INSURANCE COMPANY HAS ALREADY PAID ALL CLAIMS. THIS IS THE AMOUNT YOU OWE.

Says who? How can I be seriously expected to evaluate the legitimacy of these claims? I’ll pay the doctor whose name I recognize, even though I remember from working in a hospital that the hospital pays him; I suspect he’s double-dipping me for $300. The others could be entirely fraudulent. It’s been proven again and again that a certain percentage of people will pay any bill they receive. There have been federal cases made against people who did just that; sent bills to companies and individuals for nebulous services. One guy sent invoices for copier toner to Fortune 500 firms and got rich doing it. He never sent any toner. He just kept the invoices under $300, and most Accounts Receivable offices found it easier to pay the bill than verify it.

So I’m into these random companies for maybe $2500. I figured that at my leisure I’d start working with my insurer to verify the validity of each claim. Well, these mystery-bill people have now largely sent me to collections firms, about 30-60 days after I received the first bill from them. They are calling me in a swarm, like the big Chinese hornets of which everyone’s so afraid. I assume they’ve all pulled my credit bureaus, which show that I haven’t paid a debt late since George W. Bush’s father was President. I must look like a big fat target — which I am.

I have two choices here. I can pay everybody without question, which rankles. It frustrates me that being in the hospital for a day with the best insurance I can get amounts to a $6,000 personally-borne bill. Or I can start arguing the bills, demanding proof of service. I understand the Fair Credit Reporting Act and its associated sibling legislation pretty well. I know that the minute I acknowledge the debt over the phone I’m consenting to having my credit report blown to smithereens. I know that I probably have six inquiries from dodgy collection agencies on my credit, which would be a monstrous red flag if, say, I wanted to get myself a new Viper in March.

Or I could… or I could just drop out of the system for a while. My existing credit partners won’t drop me; they love me, I charge ten grand of travel and meals and various garbage every month. My mortgage is secure. I own all but one of my cars outright and what I owe on that last one wouldn’t buy a decent PRS. I could behave like the credit criminal they’ve already pegged me as and negotiate. You say I owe you $370? Prove it in writing. Tell you what. I’ll give you $150. But act quickly, the guys from Mid-Ohio Emergency Services are on the other line and I’m in a position to make just one collector’s dream come true today.

Whatever happens will happen. If it impacts my ability to lease a Flying Spur, I don’t give a shit. I stopped being the kind of guy who would lease a Flying Spur the day my son entered his oxygen tent. I stopped caring about driving a six-figure car in an Oxxford suit, I stopped caring about the authenticity of my watches, I stopped caring about the figure I was cutting in this world. I’ll drive my Town Car until it explodes and then I’ll put a Camry SE on my Amex and click that tempting-looking “extend my payment” box on the americanexpress.com interface.

But it got me thinking: If one night in a hospital can take me from somebody who is Centurion Card eligible to the kind of scumbag who sends three collection calls a day to voicemail, what does it do to regular people, living regular lives, budgeting every dollar? How did we become a country where you can buy the most insurance they’ll sell you and agree to every extra and still find yourself $500 an hour behind the eight-ball when you come out of the hospital?

I’ve watched this Obamacare debacle, with the stupid website and the holier-than-thou attitudes of the Democratic fellow-travelers in the mainstream media and — now — the tens of million dollars that Kathleen Delius or whatever her name is had decided to pay to a PR firm to rescue the program’s image. The whole thing looks like a giant train wreck to me. But my personal medical situation is a minor train wreck all by itself, despite the fact that I’ve done everything a responsible middle-class American is supposed to do.

What if the problem with Obamacare is that it doesn’t go far enough?

18 Replies to “In Which Our Author Becomes A Deadbeat”

  1. Tre Deuce

    ” Obamacare is that it doesn’t go far enough?” Understatement!

    PPACA _ Crippled by the for profit corporation written legislation. Now further hobbled by an administration to focused on policy and not process.

    Your situation, Jack, is one I/you here everyday when you reach a certain age and a good deal of your friends are having health issues and getting involved with the medical insurance and billing entities, valid or not.

    Luckily, I see the doc, only, every two years for my third class flight medical. Got my fingers crossed that it stays that way

    Reply
  2. carrya1911

    The byzantine layers created by various previous attempts at government solutions have been responsible for removing the direct pay-for-service relationship of those who receive care from those who provide it.

    The layers of bureaucracy allow layers of costs to be thrown in, some nefariously and some in an effort to recoup costs from people who don’t pay. The hospital charges paying patients more to make up for the patients that don’t pay. “Doesn’t the government pick up the tab for the indigent?” Not really. Not all of it, in many cases.

    The Obama administration couldn’t bring up a functional website in less time than it took to get Fat Man and Little Boy built. I’m not optimistic that granting even broader authority to the government would improve the situation. I have lots of friends who deal with the Veterans Administration…government provided, single payer healthcare. And at least two of them would be dead had their family not sought the intervention of non VA medical personnel. The rest have nothing but hatred and loathing for the system.

    Single payer isn’t a solution. Those who believe it is clearly haven’t had any experience actually using government programs before. Paperwork and bureaucracy don’t magically disappear, they get WORSE. Just like in the VA system you have to have all your ducks in exactly the right order as determined by whatever bureaucrat you’re speaking to at that exact moment, and if not well…you don’t get care. And it does you no good to say that a different bureaucrat approved X, Y, or Z form because the one you’re talking to now has a different procedural manual and that’s the one they’re going to go by. It’s unfortunate that you’re bleeding or that you are supposed to receive your chemotherapy today, but until the forms are all just so you can’t receive treatment. WE should have all the paperwork cleared up in a few weeks…assuming none of the chain of people required to approve the paperwork are on vacation, you understand.

    That’s how single payer works, folks.

    Reply
  3. Luke

    Not far enough, not even close. And we’ll never have the only practical solution (single-payer) in this country because the political system doesn’t reward actual protection of and service to the small number of people who actually show up and vote.

    The ACA was written by lobbyists and lawyers from the insurance and health care industry. The ones with the most money and access got more of what they wanted. For profit corporations are in charge of the system, protected and enriched and in collaboration with each other to ensure that it remains opaque and incomprehensible by anyone else.

    The law exists for their benefit and it will make them richer and richer while the level of service they provide will get worse and worse. The fact that half of our “lawmakers” are still incensed about the fact that a black guy got his way and (kind of) implemented the law guarantees that it will be a long time before it’s improved or oversaw in any meaningful way.

    If you want to know why the system is broken, consider the fact that me simply going in and getting a flu shot generates 1 receipt from the service provider and 3 letters from my insurance company confirming that said service was received. That’s efficiency, baby.

    Reply
  4. Jack Post author

    I had a doctor tell me recently that the best way to get medical care in this country affordably was to go to a Medicare-focused clinic and pay the Medicare-arranged price in cash.

    It’s apparently a federal crime for both parties to do this, but it is done.

    Reply
  5. mnm4ever

    I feel your frustration, my own most recent medical insurance story was when I cut my finger at 11pm on a Sunday. I had no alternative but to go to the ER as all the local Urgent Care clinics were closed. In the end I had to pay out of pocket $2000 for 5 stitches. I curse the medical system and insurance system every time I have to deal with it. I cancelled my FSA this year for exactly that reason, every single freaking time I went to use it, I had to justify my expense with a scanned receipt or they would shut it off. It simply isn’t worth the tax savings to bother. And I get “informational” letters every day about whatever services I have incurred… for no reason at all, just wasting resources. I am convinced it would be better to just keep a relatively inexpensive catastrophic coverage plan, and then self pay at the “uninsured” price for regular old doctors visits and medication. I do not envy you for dealing with this crap.

    I don’t think Obamacare is the answer, but I also know that the old system was broken and would never be fixed until it was forced. My only real hope for Obamacare is that it initiates fundamental change in the medical care system.

    Reply
  6. mike

    One word – Canada.

    I take my kid to the local clinic whenever i have any concerns, and have never had to pay a dime except for an $11 deductible for prescriptions. I happily pay my taxes for this peace of mind.

    Reply
  7. WiredChuck

    Several years ago, during a motorcycle trip in Mexico, I went over the bars of an ATV in San Felipe and shattered my left wrist.

    Within 10 minutes of my arrival at the ER, where I was one of hundred patients, I had an IV in my arm, a shot of morphine coursing through my bloodstream and a nurse prepping me for an XRay. The head of emergency medicine (who studied at UCLA and spoke perfect Emglish) explained to me what would happen next and, after examining the X-ray, explained the injury and the treatment options.

    I chose to get a temporary cast and head home for treatment, because The surgery needed to repair the damage it would have required paying cash and fighting the insurance company. The doctor set my wrist and the nurse started applying the cast. The doctor explained that many insurers cover emergency transportation home from abroad if the patient is otherwise unable to get home and requires immediate assistance. He felt sure that I would qualify, given that the two bones of my left wrist – I am, by the way, left-handed – were in four pieces and several fragments, and the fact I was on a motorcycle trip with no other means for getting home.

    I saw myself spending hours on the phone battling some mindless insurance company drone. “you’re telling me I’ve got to spend hours on the phone dealing with my insurance company just to get home?”

    “Absolutely not,” the doctor replied, “We’ll handle that.”

    With that, he took my insurance card, walked into his office and placed a call. Bear in mind, this was the head of the ER, not some clerk or volunteer.

    He returned 10 minutes later to say the insurance company was checking, and as soon as he had additional information, he’d tell me. In the meantime, the nurse had given me another shot of morphine. I had been in the er no more than 45 minutes at this point.

    Ten more minutes pass. The doctor returns. Still no update, he says. Please be patient. I’m feeling fine – god I love opiates – and not at all worried. He goes back into the office, and a short time later, I can see him on the phone. He hangs up and approaches me. “I’m sorry, but they won’t cover your transportation home.”

    (We’d planned for this beforehand; one of the guys has a brother in San Diego; he agreed to fetch us should someone get into trouble.)

    Once he was confident that I wasn’t going to hop on my bike, the doctor gave me a prescription, compiled all of the X-rays and paperwork in a file and wrote a detailed diagnosis for my primary care physician. Then he handed me a bill.

    Two shots of morphine, two X-rays, the assorted bits and pieces needed for the temporary set and cast, and his time on the phone came to a grand total of $365.

    I’m back home by the end of the next day. I see my PCP the day after that. I finally see the orthopedic surgeon three days after I’ve broken my wrist… And he schedules me for surgery a week later. Three hours of outpatient surgery, with about 45 minutes of pre-op and literally 20 minutes of post-op instructions from a nurse who saw nothing wrong with giving detailed post-care instructions – including explicit warnings of what side effect symptoms require going to the ER immediately, to a man still so clearly stoned that he’s giggling uncontrollably.

    The total bill? Just shy of $18,000.

    I can’t look at this and not feel something is horribly out of whack with our system.

    Reply
  8. John Grantham

    Had a burst appendix in March, had emergency surgery, spent several days in hospital. Paid $22 dollars for antibiotics when I checked out, and that’s it. That’s life north of the border. Doesn’t matter if you’re employed, un-employed, or self-employed. It’s a good deal.

    Reply
  9. jcain

    Good luck with it. As I’m sure you know, unscrupulous collection agencies unfortunately have a lot of power when it comes to tarnishing an otherwise sterling credit history and potentially affecting your financial life for more than the paltry few hundred dollars you “owe them”.

    Assuming you want to keep your AMEX card, read up on AMEX Financial Review before you go for the drop out method. Long story short is AMEX might shut you down at a moment’s notice and demand access to your tax filings if they think you may have suddenly become a bigger risk. Your excellent charge and payment history often doesn’t factor into the decision. Supposedly it’s happened to Centurion cardholders in the past.

    The more recent reports online (on the Flyertalk forums, for example) talk about FR being triggered by large, vaguely suspicious, charges like buying $20K worth of gift cards. However, as of a few years ago I remember reading about sudden negative information hitting your credit report triggering an FR too.

    Reply
  10. Ryan Murphy

    I think the problem is the lack of rationality in the system. You go in for treatment, but neither you, nor anyone else including the insurer and hospital, knows what it’s going to cost. A person wouldn’t ‘buy’ anything else on these terms – we will purchase something when we know exactly what it costs, and can make a rational decision. The vastly complex insurance web occludes the cost, and turns the process into a game of ‘what can I get from whom?’. There is no reason health care cannot be rationally purchased, just as any other good or service. If the cost is too high here, I’ll go elsewhere. Scarcity is a reality. Economics is about the rational allocation of scarce resources. A system which does not operate on prices, which allow rational decision making, can never be efficient. It gouges some and privileges others, but not in a necessarily predictable way. Go in for treatment, you’re spinning the roulette wheel. Who knows how much it will cost, and how much it will cost you? I had a bad experience myself with this, and ended up paying a huge out-of-pocket expense for a service I was told was entirely covered. After the fact, it’s too late – either pay the bill, or have your credit ruined. It turns out, I could have gone down the street and incurred a fraction of the cost–as far as anyone can tell, anyway.

    Reply
  11. KevinB

    My brother is a former MD and now executive with a major hospital chain in the Great Lakes region. Recently we were discussing the pros/cons of ACA and how other countries (UK, Canada, Sweden, Mexico) deliver healthcare. I thought Canada was a good system until my brother mentioned his hospital billed $8 Million servicing Canadians who were seeking quality care for things ranging from heart to hip and knee surgery. He said his hospital has come to specialize in corrective surgeries for botched hip replacements done in the Canadian system.
    Without going into all the specifics it became clear Canada (nor the UK) are systems we want to mimic if quality of care is important for everything (not just run of the mill things).
    A much better system can be found in Mexico as it’s main funding is on a cash basis so the quality is high and without the bureaucracy which creates opportunity for obscene pricing to take place. The US needs to drive the bureaucracy and red tape out of it’s own system. Unfortunately I don’t see ACA accomplishing that.

    Reply
  12. Mike

    In my 32 years of living in the UK (and now 8 years in the US) I found the UK’s NHS system to be great. All care was properly done by great staff. A lot of the buildings were old and didn`t have flat screen TV’s like US medical facilities, but frankly all I want is good care and not worrying about charges, bankruptcy etc.

    Reply

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