GeoffM

Warning: Full on rant coming up. I don't want your sympathy, maybe potential immigrants can see how life can be. For balance to the below, I will happily admit that Kaiser Permanente (KP) were not perfect but were worlds apart from this.

Okay, so my wife is a CC RN in a reasonably reputable hospital for the area. They offer their own healthcare (not all do - her previous one didn't so provided KP instead), and those in healthcare are generally assumed to have reasonably good healthcare. Our co-pays and prescriptions are $10 in-network and generics respectively, comparable to the KP plan we were on, so very reasonable indeed; no-cost for labwork.

Our son is autistic and under KP was receiving ABA behavioral therapy - this after months of testing, numerous specialists/doctors etc, which was fair enough. I learned yesterday that under Californian law the new insurance is legally required to continue this therapy. Yet nine months after starting the new insurance they have failed to provide any sort of therapy. I know his pediatrician's office staff have done their best but they are a 3rd party and can only do so much. Meanwhile I get the feeling that his school are on the verge of washing their hands of him - which they shouldn't be able to do so easily but that doesn't stop them trying. Yet he received a prestigious reading award just the day before the latest day he was sent home from school early (3 times in a week now).

Switch to me and I need a "scheduled" drug. Not really a problem but on January 1st our insurance demanded that the doctor who wrote the prescription phone them to re-authorize the prescription. Quite why is beyond me when he only wrote the prescription two weeks before but they blamed the ACA. He was not allowed to phone before the 1st and due to sheer incompetence of his front office staff and them denying that they received the faxes from CVS (despite their fax machine confirming receipt not once, not twice, not three times, not four times, but five times - one from MY fax machine) I didn't get the prescription refilled until 2 weeks after I ran out, end- and mid-January respectively.

Not content with that, that prescription didn't work so I had to see him again. Two weeks to get authorization from the insurance to see this doctor, even though referred by my primary physician. Of course, he wrote a new prescription that also needed authorization from the insurance company because it was also a "scheduled" drug. Another two weeks of repeated faxes from CVS to the doctor's office. Friday last week I phoned them and they said "yes, we have it, the doctor will phone this afternoon". Monday I phone to check and the answer is "We don't have any information about this. Can CVS fax us again?". "For the fourth time?" I say, after which they put the phone down - I was not rude, just asked direct questions. Phone them again, no answer. Phone from the landline, instant answer, immediate guilt. Phone the insurance company, and CVS, get them both to fax this doctor's office, and a couple of hours later lo and behold the prescription is finally authorized.

But that's still not all! The very next day I get a letter from a debt collection agency for $200 (plus fees)! This was the first I'd ever heard of any debt relating to this doctor - yes, the same doctor as the paragraph above. Some phone chasing later and today they admitted the debt was a complete mistake and would be withdrawn with an apology sent. I'm sending a letter to the debt collection agency anyway as I couldn't trust this doctor's office to organise a piss up in a brewery let alone cancel a non-existent debt. FWIW I don't have a problem with the doctor himself: it's his front office staff that are the problem.

Why not get another doctor I hear you say? Well, our insurance authorizes exactly two pediatricians - more recently three - one this, one that, zero pediatric psychologists in-network, etc, etc. Yes we had a choice of health plans when we signed up (and re-signed up for January): you take what's offered, or you don't. That was the choice. We travel an hour for DS's psychologist, and our daughter, who has an identical eye condition to me, is not allowed to see the same eye doctor that I see locally, so we have to travel an hour for her's as well - and they recently sent us a bill for $100+ because insurance didn't cover it all.

Oh we fight it, trust me. Literally a couple of hours a week we're on the phone or faxes to insurances, doctors, etc. We're not even that sick really! The amount of time we spend makes me wonder whether we're actually better off paying privately for health insurance - with KP would be our first choice, but it's expensive, something like $1500 to cover us per month. Though I have a company, 1-man businesses aren't qualified for small business cover - not really sure whether that helps with the premiums anyway.

Not really relevant to us but several months after we switched from KP we received statements from KP indicating how much the 3rd party ABA company had charged KP for services. In the statement were several "home visits" dated long after we moved. Naturally I contested this with KP because I feared being charged non-covered rates as we didn't have insurance then. They agreed but I don't know what actually happened - except a flurry more statements come December/January when they clearly wanted to meet some sort of budget for non-existent services.

I actually wonder whether the resistance to some sort of universal healthcare is actually that millions of people would be unemployed because there would no longer be the need for vast legions of people just assigned to billing, fixing bills (in both senses of the phrase!), adjusting ridiculous demands from doctors, and taking calls from angry customers trying to get their bills corrected.

Yet despite all this I fear that despite all this I still have not experienced anywhere near the worst that US healthcare has to offer (or not). We're lucky to be insured quite frankly.

Well, that was cathartic. If you got this far then well done and thank you. Again, I'm not after sympathy, just trying to warn others that US healthcare may or may not live up to expectations.

scrubbedexpat091

Wait until the insurance company decides they are not going to pay for a sizable claim that should be covered but they know the little guy can't afford the legal team needed to fight it.... That was pre-whatever it's called though, but pretty sad when bankruptcy is the best option because a billion dollar insurance company won't pay 30k for something they should cover.

The US system has been screwed up for decades and it's not changing anytime soon, I'd have a heart attack having to deal with the BS down there with regards to healthcare.

Ash UK/US

The health CARE I have received here has been very good, the health SERVICE here is an absolute disgrace.

It seems like every bill/statement I get has an issue or mistake, I waste so much time correcting it. As you said a universal health system would put a lot of paper pushers out of work.

WEBlue

This! Paying for US healthcare is the worst kind of swamp that swallows hours & hours of people's time and saps energy and hope. I think it makes many of the illnesses the US medical system is supposed to "help" much worse...Just the prospect of having to call my doctor's office and question someone in 'billing' yet again about yet another mistake makes me ill.

And then there are the insurance companies.... The lack of transparency there is stunning, likewise the absence of oversight or sensible regulation. I'm convinced the companies make deliberate errors in their financial favour (and wait to see if anyone fights before rectifying them), though some are laughably "real" mistakes completely due to pure incompetence.

We just changed insurers this year, and yesterday I went for a blood test my PCP had prescribed last year. Before I could have the test, I sat for almost half an hour with the "billing" lady who was quite baffled by my new insurance card. When she plugged in my ID numbers, she said 6 choices came up on her screen under my insurance company. She had to confer with two more experienced 'billing' folks to figure out which plan I fall under. What a ridiculous mess!

Redwing

I could not agree more.

username.exe

My backup plan for dealing with the Healthcare system here is simply to just bite my lip, think of England and walk it off.

I have always hoped to goodness I don't have to deal with any serious medical issues but having a young family it is simply inevitable that we will at some point.

dunroving

One thing I really don't miss about living in the US is dealing with health care payments and claims.

SanDiegogirl

I truly sympathize.

When on my own private health insurance I dreaded going to the doctors as there were invariably problems with bills - and I went to the doctors rarely!

Now on Medicare it seems more straightforward. The bills go to the Medicare authorities and get paid. You know what your co-pays or deductibles are.

The only issue is that some doctors offices don't take into account that I have a supplementary policy and instead of billing that company they sometimes bill me.

If everything went to a single payer organisation, I'm sure it would be simpler.

scrubbedexpat099

They solved the problem in my County, closed the Surgery last year, Pharmacy this year.

Pulaski

This won't help the OP, but seeing as this has become the usual rant about healthcare in the US, a lot of the administrative issues with the system are caused because the health "insurance" system is being used as a payment system. If car insurance reimbursed the cost of servicing, cleaning, tyres, and parking (in addition to repairs of substantial accidental damage and third-party liability that it actually covers) it would be the same sort of administrative nightmare as health insurance is. The system would be much easy to manage if people paid their own on-going run of the mill expenses and only claimed on insurance for costs they could not meet from their income, just as we do with cars and car insurance.

scrubbedexpat099

So true

GeoffM

Yes, the doctors and nurses are usually great; it's the faceless bureaucracy propping up the system that kills it for me.

For those not familiar with KP, this is one of the few companies that is both the insurance AND the healthcare provider. So they own the hospitals and clinics, and employ the doctors and nurses. You get statements and pay co-pays no different from anywhere else. Not much is supplied by 3rd parties - ABA as indicated above is one. But you have to use their pharmacies and there may be limited choice of doctors - though a bigger selection than what we have for the same area. Everything is computerised so your records can be accessed from anywhere (let's hope their security is good) - no time spent filling in exactly the same 6-page form that you did last week for that other doctor. As I say, not perfect, but we didn't realise how good it was. It will certainly make us think more carefully next time if it affects health coverage.

SanDiegogirl

It was not meant to help the OP - he is not looking for help; he wrote in to describe what a nightmare the health system can be in the US. I'm just sympathizing.

Are you suggesting that insurance should not pay for visits to doctors, on going treatment/checkups, xrays, outpatient treatment etc but only pay for 'big expenses' like hospitalization?

scrubbedexpat099

Some of that stuff may be quite major, but the small stuff absolutely.

Pulaski

There are good reasons, and ones I entirely agree with, for insurance to cover preventative care and screenings, but with that exception, to answer your question, "yes". .... If you cut your insurance bill from say $800/mth to say $400/mth most people (though not those on low income) could afford to deal with most basic visits and cheaper treatments from their income. ..... And not only is that what I am saying, it is also what the Pulaski family is doing.