[cancer] Best healthcare system in the world, my tumor-riddled ass

One of the drumbeats from our friends on the Right here in the United States is that Obamacare is some kind of socialist plot to undermine the best healthcare system in the world.

Only someone who has never been enmeshed in American healthcare could say that. Our treatments and outcomes are generally pretty good — though not always, viz our infant mortality rates, for example — but the healthcare billing and payments structure is a bleeding nightmare.

I discovered last week that my medical oncologist, whom I have been seeing since 2009, is suddenly being classed as out-of-network by my health insurance carrier. This means instead of my $40 specialist co-pay, I am responsible for $283.59 for seeing an out-of-network provider with each of my biweekly visits.

This has still not been cleared up, but to date I have made or received ten phone calls to either my insurance carrier or my treating hospital, and with transfers, spoken to or left voicemails for seventeen different people. I have discovered that my hospital has multiple departments known as “managed care”, and multiple departments known as “billing”, and that even the people who work in those departments cannot tell me the difference, or necessarily know what to do if my call has been accidentally transferred to the wrong department.

Meanwhile, my doctor clearly shows as in-network on my insurance carrier’s own “Find a Physician” web site. Yet when I call the claims group, they tell me my doctor is out-of-network.

Because reasons.

It turns out the problem is actually that on 1/1/2013, the address of record for my doctor changed from one of my hospital’s multiple street addresses to a different street address. This caused the tax ID under which they bill to be different. Apparently, my hospital’s billing department (or one of them, at least), has not yet caught up to this little factoid.

Meanwhile I, the stressed out and distracted late stage cancer patient, am responsible for talking to at least seventeen different people to get this straightened out. The hospital isn’t doing it because they get paid either way. The insurance carrier isn’t doing it because by billing out-of-network they save money. It all rests on me. Another part of the fundamental cruel illogic of our social system.

I have spent more time on this problem than I spent talking to my oncologist about the fact that my cancer is now considered incurable. Think about what that says about our systemic priorities.

To put it all in simple terms, in a single-payer system, none of this would be a problem.

So you think this is the best healthcare system in the world? Walk a mile in my shoes, then say that. On the pointy end, where medicine is practiced, I have very few complaints. But the ridiculous for-profit payment processes can be a freaking nightmare.

45 thoughts on “[cancer] Best healthcare system in the world, my tumor-riddled ass

  1. Laurie Mann says:

    I think if you have a relatively uncomplicated condition, have good insurance, and if you can keep an eye on things, it’s not terrible. I’ve certainly had frustrations with the way my situation’s been handled, but usually a phone call or two cleared the situation up. BUT, you’re right, everything would be much easier under a single-payer option. And for people with a complicated condition, it’s insane. I also feel badly for my folks, dealing with various forms of MediCare and insurance.

  2. Stuart Clark says:

    As someone who moved here from the UK, I find the healthcare system in the US just unbelievable. My wife and I have only had minor complaints over the years, but the amount of billing mistakes and time we have wasted trying to get things sorted out just blows my mind. I can’t imagine how much money just gets wasted in administration. This is what happens when you run healthcare as a business and not as a service. Sorry to hear of your troubles Jay, on top of everything else.

  3. Harald Striepe says:

    Angry quote from my oncologist: “When we are talking about our intended practice, the shadow in the room with us is not my advising colleague from Stanford, but the billing dept from your insurance.”

  4. MtnSk8tr says:

    Jay, you are more tactful than I could ever be on this subject. Speaking as someone who wields the Pointy End, stories like this are all too common. What you (and millions of others) undergo in the Insurance Jungle is nothing short of unethical and immoral. It makes me sick.

    BTW, if you have the energy &/or ever want to see me foam at the mouth, remind me to tell you about the 1992 Nicholas Thresher bone marrow transplant case — which is the story of a pediatric oncologist playing hardball against an insurance company for his patient (and eventually winning).

  5. neth says:

    Yeah, it’s ridiculous. I have a daughter with a heart condition and she is in weekly therapy for related oral motor issues. With all the various care, therapy, prescriptions, medical equipment and such that she requires, my wife and I (mostly my wife) spend 2 to 8 hours per week managing the (generally inaccurate) paperwork between the insurance and providers. She has literally had to cut out time at work (and our income) to be able to deal with it.
    Combine this with a new corporate policy (as of last year) that reduces my sick time 40 hours and I’m more than fed up with current model. Someone trying to set up a broken system couldn’t do a better job.

  6. Alex says:

    Infant mortality is a special case. Statistics are skewed relative to other countries because doctors attempt to save many “premature babies” that elsewhere would be counted as miscarriages. Doctors do push the boundary and a few of these babies survive past infancy (obviously many with birth defects). One might question the allocation of technology and resources, but there is a reason for the numbers. Though of course poverty and lack of public health care do factor into this somewhat as well, but my understanding is these are secondary factors for this specific outcome.

    The rest of your article is spot on. I’ve heard it said that the reason Canada has proportionately more authors, artists, and other creative people is that in the US, people don’t have the luxury of freelance jobs without benefits. Here in Canada, I have a housemate who works as a freelance editor. She had breast cancer 23 years ago, and she’s had a few other bouts with cancer since. (Currently her tests are clear.) Science and medicine are what they are, but in economic terms, it doesn’t affect her, which means she doesn’t have to skimp on treatment and she can pursue her life in ordinary ways as she chooses. The cost of my friend’s treatement in 1990 was less than half her income from that year, but it’s only a fraction of the taxes she has paid since.

    In civilized countries, health care is considered a human right. It’s economic nonsense to put the burden of paying for healthcare on people who are made unproductive by the lack of it. Even the very small step of “Obamacare” will be more than paid for by the taxes and economic output of people who would otherwise be marginalized, or dead.

    Wish you best of luck, hope science and medicine are able to help you, and hope you can find a way to pay for it all.

  7. Philip Slocum says:

    the entire systems is flawed badly. I used to spend $10000 a year in insurance. Not any more. I move out of the country. The angiogram that cost $87,000 in the US cost $4,500 in Bangkok at one of the better hospitals in the world. Everything about American medicine is a ripoff. its cheaper to fly overseas and have a procedure and have a holiday at the same time.

  8. Carolee says:

    Amen! I’ve lived with type 1 diabetes since I was 4. Like it’s not enough to deal with a disease that impacts your daily living so much, you have to constantly fight for benefits and keep an eye on the “mistakes” that somehow always seem to be in their favor.
    I’m sorry to read about your cancer- I hope your joys are many and pains few at this crazy time. (The insurance company doing its job would be a good start, eh?)

  9. I had cancer treatment here in the UK and from start to finish all I did was turn up, get treated and sent home, my friend in NYS had his treatment around the same time. When we spoke his days were full of “These f’**ing forms I HAVE to file right in the middle of chemo week, so stressing but have to be done or I sell the house to pay for the treatment”

    Its never about the treatment – its ALWAYS about the $billionaire insurance companies.

    So angry for you right now – like you REALLY need to be dealing with this!

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