My wife and I both had pneumonia in February. Just before that, I had a colonoscopy, and my wife saw an ophthalmologist. Months later, I’m still not quite sure how much we will have to pay “out of pocket,” even though we have been the recipients of 68 pages of bills and benefit statements from Medicare, Blue Cross Blue Shield, and the medical providers.
The benefit statements list specific medical services, the date provided, the name of the provider, and the code for the service that was provided. Cryptic statements indicate what was charged, what was “allowed,” whether the service is covered, and an amount that we “may be” liable for.
Medicare statements arrived first. The amount they say we “may be” responsible for includes amounts that BCBS may pay. The statements from BCBS arrived next. The amounts they say we “may be” responsible for are lower than what Medicare’s statements say, but I can’t tell what these amounts represent.
Finally, the bills from the providers arrived. The amounts we “are” responsible for match neither the amounts listed by Medicare nor by BCBS. It’s not obvious exactly why these amounts weren’t paid by Medicare or BCBS. Nor can I tell, without painstaking efforts, if these bills cover all the services listed on the statements from Medicare and BCBS.
There was some error in the ophthalmologist’s bill, requiring two lengthy phone conversations and resubmission of the bill to Medicare.
Think about the absurd amount of time spent by Medicare and BCBS in receiving the provider bills, verifying codes, determining what was and was not covered, determining the status of deductibles and co-pays, determining whether the amount charged exceeds the insurer’s allowed charges, generating the lengthy statements, printing them out, inserting them in the envelopes and mailing them out.
Think about how much time providers spent ensuring that they properly coded their services and submitting the bills. Now at least four months since these services were provided and they still have not received full payment.
Think about how much time I have spent inquiring about and reviewing this tower of paper.
This is what “good” medical coverage looks like? We absolutely need a sane, efficient health care system like Improved Medicare for All.