Friday, April 29, 2011

Healthcare: Where simple things get hard

Regular readers of this blog – both of you – may recall me describing a small dispute over a medical bill, and how I was grateful to Anthem Blue Cross for stepping up and agreeing to take care of it (see "A health insurer admits it's wrong").

Well, like so many things in the American healthcare system, it didn't turn out quite that simple.

First, Anthem didn't pay the bill, as I had thought. They cut the amount I owed from $61.50 to $49.41 based on their contract rates with MemorialCare (operator of Long Beach Memorial hospital). I still had to pay the $49.41, which would be applied to our annual deductible. OK, fine.

But MemorialCare continued to bill me for $61.50. Yesterday, I called MemorialCare and the woman I spoke to said that they had never received any notice of an adjustment from Anthem. So I called Anthem. The representative I spoke to there sounded actually rather indignant that the MemorialCare was still billing us for the original amount, and immediately called them. She promised to call me back, but never did. Sigh.

So I called again today. I spoke to Anthem representative Emma, who immediately set up a conference call with myself and MemorialCare representative Betty. Emma politely explained the issue, while Betty snippily retorted that they had never gotten a notice from Anthem adjusting the bill. Emma politely said she would fax it, while Betty snippily asked, "Is it the EXACT same thing you mailed us? Because if it isn't they won't accept it." (My thought: "You say you never received the mailed statement – how would you know if it was the exact same thing?')

So perhaps this will all be settled now (I hope). But the bigger issue is this: This whole dispute boils down to just $12.09 – the difference between what Anthem says we owe and what MemorialCare says we owe. Yet it has taken months to resolve, with numerous phone calls, faxes, mailed bills and statements. Multiply this kind of inefficiency and waste by millions of different claims and you can see why healthcare costs keep going up.


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