Friday, November 06, 2009

A letter to Congressman Murphy on health care [guest essay]

by Ben L.

(also see his essay America's Great Healthcare Denial of Service)

Dear Representative Murphy,

I would like to tell you my story, which is only a small horror story in the context of this wretched system of wasteful, greedy health care in the US. Hopefully, there is a tipping point where the people make their will known for a simple, effective system. Everyone should have access to care.

This year, my health care provider (HMO to PPO) changed from MVP to United Healthcare. Since then I am left to the wolves for fighting for benefits that they promised to me and then denied. I can see no mechanism that punishes them for the denials -- only their own benefit of stealing money from their members, from providers, from institutions.

I have Crohn's Disease. It is a chronic disease that requires medication to keep my condition from going into painful inflammation.

In October of 2008, I began trying to verify with United Healthcare (UHC) what my out-of-pocket expenses would be for covering Remicade infusions (for treatment of Crohn's Disease). After many phone calls, I received assurances in January of 2009 that the procedure would be coded and billed as an office visit and I would be responsible only for the co-pay. At this time I was coordinating services through Gastroenterology Associates of Northern NY in Glens Falls (through Dr. Michael Chase) as well as Glens Falls Hospital.

In April, I received a bill from Glens Falls Hospital for $1,677.09. This was for my first Remicade infusion for the year. The relevant UHC claim is [number].

A subsequent infusion was performed on 3/17/2009 and I again was billed using this different criteria. This time patient responsibility is set at $603.24 and UHC is now saying that this is the remainder of the maximum out of pocket expense for the year. (Although, actually I have been billed for $645 more because my gastroenterologist who I thought was in-network is out of network even though there are no local gastroenterologists in network, there is a different out-of-network out-of-pocket maximum than the in-network out-of-pocket-maximum -- this has subsequently been resolved after 3 appeals with UHC and another appeal through Tribune Company who actually self-insures the plan with UHC administering).

Although the hospital expenses appear to be a difference in how the billing is coded, I have not been given any direction or opportunity or redress to get them coded in a manner that is compliant with how I was described this process would work (and what my payment responsibility would be) as consistent with what I was told at the beginning of the year. For Dr. Chase’s bill, I was told that I would be able to obtain a waiver because there are no in-network gastroenterologists, but this has been refused in appeals with UHC.

I would like to get this figured out soon as I am getting a lot of bills that I do not feel I should be responsible for with “Past Due” and “Final Notice” on them. These bills in question are:

Glens Falls Hospital service date 1/20/2009 $1,677.09
acct# [number]

Glens Falls Hospital service date 3/17/2009 $603.24
acct# [number]

I am in the bad debt file over in the hospital and have 30 days to resolve the matter (pay the debt, set up a payment plan, etc.).

Please, please, please do something to reform this system, rife with abuse so people who are sick are not attacked by predatory corporations.

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