Thursday, January 27, 2011

Now that's some efficient health care!

Just had a really bizarre complete waste of my time... Our family practitioner's office called me and said a bunch of claims for my wife and my son were denied -- from 2009. I don't even have the same insurance anymore. The explanation on the EOB was "do not provide that service", and apparently the insurance company told the provider that I would have to call.

So I'm fuming of course... I mean, 2009?! WTF? Luckily I didn't really have to wait on hold, although, the phone menu wanted to fuck me over, but mercifully I got to a point where I could just mash 0 and get to an operator. Talked to the person a bit... apparently there were only two "claims" (although the one on my son was apparently a whole bunch of separate claims that got lumped into one or something) that had failed to go through because there was a computer error while the claim was being submitted.

Yeah, that's it. A short-term computer glitch. All that needed to happen was for the insurance company to resend the claim to their computers.

So I have two questions: What kind of shit-ass IT setup do they have where if there is an intermittent network error while processing a claim -- and it appears to have been internal to the insurance company, no less -- that it requires the intervention of no less than three humans in order to recover? And second, why couldn't the insurance company just work this out with my health care provider?

In a perfect world, the system should have recovered automatically. Transmission error during claim submission? Okay, retry! Failing that, it should have been one phone call between my health care provider and my (former!) insurance company. I mean... really?

Single payer, man, single payer. It's looking better every single day.


  1. Single-payer should look better and better to a whole lot of people, but we need to tell Americans, since most have not heard of Improved Medicare for All. They were, instead, taught to have a horrible fear of a health-care-for-all system (the most efficient being single-payer), even though EVERY other free-market country has a health-care-for-all system ... and testimonials of Americans in those countries indicate that it's fine.

    I have personal stories also ... and stories of Canadian-Americans who go back to Canada. One young man in his 20's needed health care here, unfortunately. He's now living back in Canada with decent health care at a decent price. Show card and get care.

    But, addition to individual stories are, of course, the realities of what is going on here.

    We must replace the March 2010 Law ("Obamacare") with something infinitely better. What was signed into law in March 2010 (PPACA/HCERA, the "Affordable care Act of 2010") will cause our health care costs to skyrocket, our taxes to increase significantly, and millions of us to experience government intrusions on our lives.

    With Improved Medicare for All ...
    ... (without Medicare's current expensive privatized parts) ...
    ... we will cover everyone, not leaving out over 20 million Americans,
    and have ...
    ---- the best health-care-for-all system
    ---- more jobs and better health
    ---- more freedoms
    ---- less government plus much less for-profit and supporting bureaucracy.

    We can and will ...
    -- get more benefits
    -- pay far less money
    -- experience dramatically fewer hardships
    -- pay no major medical bills, as documented by the positive experiences of Americans living and working in the other free-market countries
    -- have no bankruptcies due to illness or future massive medical debts.

    As per the testimonials of Americans living and working in countries all over the world (pardon the important repetition), we will achieve the following realistic vision of a health-care-for-all system.

    - Bob the Health and Health Care Advocate

  2. Sorry about the one broken link, which is for one of THE MOST IMPORTANT FEATURES of a health-care-for-all system, especially compared to our current situation:

    We will have no bankruptcies due to illness or future massive medical debts.

    - Bob the Health and Health Care Advocate

  3. Hey, James, what happened to my original set of comments with links to information about Improved Medicare for All via single-payer health care?

    I thought from your blog post above and your previous one in October 2009 (here) that you are okay with having you and others have some information about single-payer.

    If it's the size you don't like, I could shorten it.


  4. I'm not sure where the original comment went. I got a copy of it in my e-mail like usual... I don't think I have any sort of moderation turned on... I'll repost it if I can't figure out how to restore it.

  5. Ah hah, Blogger apparently added a spam filter on comments (I had wondered why some of Markuze's comments were getting filtered out!) Must have been all the links.

    I will look at what you wrote and respond later. From a brief skim, it seems we are of a similar mindset, though you have thought it through a lot more than me! OTOH, I tend to feel that Obamacare, as flawed as it is, is an important foot in the door. If we can just get to 2014, when every American is insured... then to argue against universal coverage will be a politically untenable position.

    I also found out more about this specific issue. Turns out my employer was the one who screwed up (back in '09 somebody restored a database from the wrong backup tape, and it wiped out everybody's dependents -- and instead of fixing it, they only fixed it for people who noticed and complained!) Makes the insurance company itself look slightly less shitty, but it still exposes the horrible inefficiencies inherent when you have so many frakkin' parties involved.

  6. I can't believe that so many physicians in private practice have been hoodwinked into mobilizing against a single payer system. Their bread and butter is Medicare, not insurance companies. Insurance companies refuse to pay them, and don't pay up for years! Not the good old Socialist Security Administration. You send them a claim, they send you a check.

  7. I think there is somewhat of a fear -- and somewhat justifiably -- that while single payer will increase the reliability of doctors getting paid, their overall pay level will decrease.

    I think one way or another that is inevitable (the present system is laughably unsustainable) but single payer could potentially hasten that.