Years ago during business school a Canadian friend of mine had painful hand surgery followed by difficult therapy to regain her strength and dexterity. The most painful and stressful part was dealing with the bills. She had good insurance through the school but somehow got hit with a giant bill from the hospital after her insurer denied it. Through no fault of her own it seems she had occupational therapy when her plan covered physical therapy. (Or maybe it was the other way around, who knows?)
She was somewhat incredulous when I told her she didn’t have to pay the bill, that mistakes like this happened all the time. Eventually she got it straightened out and the insurance company paid. But it was something a life spent in Canada had not prepared her for.
Multiply this experience by 300 million or so and you’ve got a pretty good description of what’s going on in the US health care system. The New York Times (A Guide Through A Medical Wilderness) describes the various medical cost advocacy services available to patients who get tangled up in the system. The advocates do everything from appealing insurance denials to helping with paperwork to negotiating with doctors and hospitals to finding mistakes on bills. It’s an expensive, complex setup and yet it’s necessary for patients like the one described in the story who received a $16,000 bill for an air ambulance 5 months after the fact.
These services are a lifeline for people without insurance, and even for people who have insurance, since there are so many gaps and charges that patients have to pay for themselves. Truth is the insurance companies also use industrial versions of the same services. The whole things adds up to a colossal use of resources that drives costs sky high.
The solution to this problem is pretty simple: a single payer system. (Although I’m not saying that’s the right way to go overall.) It should be pointed out that single payer is not on the table –and won’t be for a few more years until people get really desperate. In the meantime expect the medical cost advocacy business to continue to pick up steam.August 7, 2009