The Plot Thickens (Or Know Your Doctors, Even If You Cannot)

To recap from the previous posting, we are being charged thousands of dollars for services we made use of in the past, retroactively, by a group of physicians we didn’t know existed.

This is turning into a real-life Catch-22. Innocence is no excuse for not paying.

We talked with a representative of the Pathologist group. He claimed that they did not have any responsibility in informing us of their withdrawal from the insurance plan. It’s the insurance company who’s responsible in informing us.

We also talked with a couple of representatives from the insurance company, who informed us that it is our responsibility to verify that the doctors whose services we use still belong to the insurance plan.

Do you see the problem (the catch) here? The problem is that we don’t ever meet any of the doctors in question; we didn’t even know they existed until this latest episode. To us, there are people who process the blood and bone marrow samples from us, but those people are part and parcel of the lab service that we make use of. How can we know that a hitherto anonymous group of people dropped out of our health plan? Are we, the patients, required to have god-like powers?

The Best Healthcare in the World?

Imagine that you bought a premium all-inclusive tour
package, and a few months after the trip, you got a bill from the Chefs Group,
claiming that they are now an independent entity, and must be paid separately and in addition to what you’ve already paid.
Would you be surprised? Annoyed? Or would you be using even stronger words or
non-verbal expressions?

Well, essentially the same just happened to us, in the
setting of health care!

I was diagnosed with a type of leukemia more than two years
ago, at a local university hospital. Fortunately, with a new kind of medicine,
the disease is well under control in short order, and has been basically in
check ever since, with occasional ups and downs. Unfortunately, we learned that
there is no uniform way of performing blood tests and keeping track of the
progress of the disease, so we have decided to pay about twice the insurance
co-pay, $35 instead of $18, for the privilege to keep using the university
hospital’s diagnostic testing facilities, instead of an outside lab, so that
the tests are at least longitudinally comparable. And we are very careful to
maintain our health insurance, keeping the options the same from year to year.

However, recently, after going through the routine for
dozens of tests, we got a bill from a “Pathologists Group”. Upon inquiries, I
was told that they’ve decided to no longer accept our insurance, and would now bill
us directly. So all of a sudden, in addition to the $35 to the hospital for
taking my blood and bone marrow samples, I must pay hundreds of dollars, and
maybe more, to those who analyze the same samples! On top of that, for about
half a year neither the doctors’ group nor the hospital told us about this
change, even while I was using their facilities once every several weeks! After
talking to someone representing the group for the first seemingly erroneous
bill, I now understand that for each visit two or three bills are generated
from the group, with most of them still unseen to us. From the couple of bills I’ve
seen so far, I fear that unknowingly I have become indebted to them to the tune
of several thousand of dollars!

I can understand the physicians who want to be paid better. I
owe my life to the physicians who diagnosed me, treated me, and to those whose
research brought the treatment to patients like me. And I’m ready to pay with
both my gratitude and my money (including insurance money) for their work. But something
in this new system is wrong. For one thing, where in this change of billing is
any consideration for the patient, either in its rationale, its process, or its
communications? Assuming it is legal, how can it be ethical to have different
groups of professionals in a hospital to start charging patients separately? Should
I start to develop a check list of medical and service professionals working
for the hospital for each of my visits, in case some other group becomes
independent in the future?

I cannot wait for President Obama’s health reform to take effect. Our
healthcare system seems to be crumbling down, even if it were the best.