06-26-09 - Guide to Health Care

God damn I keep getting screwed by providers and the insurance company. Here are some tips :

1. Do your own research, find the specific doctor you want. This can be hard to do, but you should be able to find the local specialist in your problem. I recommend someone young and up & coming because they will actually care and be up on modern techniques. The crucial thing here is the difference between a good doctor and any old doctor is like night and day. Don't be afraid to just leave a doctor after one visit if you don't think you're getting the attention you need.

Specifically - if you have an injury where you get an MRI, you should expect a doctor to actually LOOK at the MRI. The first two doctors I went to literally didn't ever look at it. They order MRI's and make a ton of money off you and then just read the examiner's report. The MRI examiner is not an MD and not qualified to be making judgements on your condition. Furthermore, if you have something like a sports injury, if the doctor does not actually look at your body, eg have you take your clothes off and move around and show him the disfunction - you should walk right out of there.

2. Do your own research on how you will be billed and who will treat you. This is tricky and you cannot trust ANYONE on this matter. You will be told that the person who will treat you is "covered" by your insurance. That doesn't mean anything. They may be outside your "network" which will cause them to bill you at a very high rate. Assuming you are on an HMO/PPO plan of some kind you must find specific providers who are "preferred" or "in network". You must do your own research on this because no one else will.

Pursuant to that - it's not enough to know that a certain office is "in network" for you. You must call ahead and get the name of the exact person who will be treating you. Twice I've gone to PT offices that I was told were "in network" for me, and then the exact person I was assigned to was out of network. This can be rather tricky - when you go in to a doctor who's in network for you, he might send you into a room to get xrays, if the xray tech is out of network, boom you're fucked. The classic one that people get bit by this was is the anaesthesiologist. Often when people get surgery they find a surprise bill for $10,000 from the anaesthesiologist who's out of network for them even though the doctor/hospital/everything else is preferred.

You really have to be a huge asshole about this, you need to call ahead and get the names of everyone who is going to treat you and check on them. When you go in to the office, you need to be firm, any time someone walks in a room to treat you, you have to say "who is this" and if they're not a name you've checked you have to say no. I know this is ridiculous and often not possible in practice.

3. When you get bills, go over everything with a fine toothed comb. Providers will bill you directly for the balance not covered by insurance. Quite often they do this wrong/illegally either on purpose or by accident. Of course the health insurance often fails to reimburse correctly too, so check on that as well. If the doctor takes your health insurance, then they are not allowed to bill more than the negotiated rates; this amount is normally marked "not allowed" on your explanation of benefits. Often the doctors will go ahead and bill this to you one way or another; this is called "balance billing" and it's specifically illegal. It can be tricky to spot sometimes because they mix it in with allowed billing, so you have to do the math and see that all the billing amounts add up right.

When you get bills that don't look right to you, you have to call your health insurance and your provider. If it's a question of "balance billing" you just confirm it with your health insurance, and then tell your provider to fuck off. The other common problem is something is getting billed at a higher rate or not covered when you think it should be. I've had more luck calling the provider about this kind of thing, the health insurance will just tell you tough luck. The provider can be a little funny about how exactly they bill things, so if they change the billing code and resubmit they may get more coverage; they are usually happy to do this, you may need to talk to the head of the billing department or whatever.

Anyhoo, if you have some kind of Orthopedic problem, I highly recommend Dr. Chris Wahl. I haven't actually had surgery from him, so I can't comment on his surgical skills (anecdotal reports on surgical outcomes are pretty worthless anyway, we need fucking public statistical analysis of doctor's outcomes, but of course the corrupt greedy bastards at the AMA would never allow that). He's the first doctor I've ever had that actually looked at my MRIs. He's also the first doctor who even gave me a proper physical visual exam, as in I took my shirt off and he immediately said "hmm your right shoulder is dropped, looks like you had a type 2 sepration". Yes! yes I did, and both my previous doctors failed to diagnose it.


nothings said...


nothings said...

er, this

cbloom said...

Oh yeah, when you actually look at the codes for what they're billing the insurance companies it's quite revolting.

One thing I noticed in my case, since I'm going in for injuries in both left & right shoulders, every doctor is billing everything twice.

So a regular doctor visit where he sees me for 5 minutes is

patient exam - left shoulder - $250
patient exam - right shoulder- $250

cbloom said...

And the whole attitude of "it's insurance I'm not paying for it" from both the doctors and the patients is frustratingly retarded.

Sly said...

> patient exam - left shoulder - $250
> patient exam - right shoulder- $250

:o :o

Hem... What's about moving in a more civilized country? There's one a few tens of miles north from your home (actually I'm not sure for the English part of it).

cbloom said...

"Hem... What's about moving in a more civilized country? There's one a few tens of miles north from your home (actually I'm not sure for the English part of it)."

It's cold up there. And people talk funny.

Sly said...

Hehe true, true.

castano said...

Ugh, one of the things that I like about Kaiser is that you don't have to deal with bills at all. On the other side, everybody in the system has incentives to cut costs down and you have to fight hard to actually be taken care of.

I finally got an epidural steroid injection (after 6 months asking for it). The most disturbing thing is that the injection was taken under x-rays, not because the doctor actually needed it, but in order to keep records of the whole thing and protect themselves from lawsuits.

In Spain this is a procedure that is done at your home or in the ER on your first day of acute pain. Now my nerve is so damaged that I still have some pain even after the inflammation has gone down.

old rants