“ALL BUREAUCRACIES, PUBLIC OR PRIVATE, are the same” is a motto I have lived by for years, and it applies to the health care and health insurance bureaucracies. I purchase a full price individual health insurance policy on the Massachusetts Health Connector, and previously purchased an individual policy before the implementation of Obamacare. It is my belief that the Affordable Care Act is unfairly blamed for much of what is wrong with our medical and medical insurance bureaucracies, and this bias has been exploited by its opponents. There is plenty that is wrong with our health care and health insurance systems, most of which would not be corrected by repeal of the law. The next three examples are of course merely anecdotal, but illustrative.
Last year, I went to my eye doctor of nearly 20 years for a routine exam. As usual, the doctor’s office billed the insurance carrier for the visit. Here’s what happened next, as best I can figure out: Upon receipt of the bill for approximately $150, the insurance company “re-coded” it as a bill for outpatient surgery, for which my plan allowed approximately $450. Despite the fact that I have a platinum, allegedly no-deductible plan, the insurance company notified the doctor that I was required to pay the first $500 and that the entire bill was therefore my responsibility. The doctor’s office then took the $450 amount allowed for outpatient (non)surgery, instead of the $150 initially charged for the exam, and billed it to me directly.
After I explained to both the doctor’s billing office and the insurance carrier what they had done, both insisted that the issue could only be resolved by the other initiating a request for correction, which they both steadfastly refused to do. Several months later, I received a notice that the bill had in fact been resubmitted by the doctor, but coverage was refused because it was now too late, so I appealed that ruling – for the obvious reason that the delay was caused by the insurance company’s initial mistake. Sometime later they professed to have no record of the appeal. Subsequently, and apropos of nothing, I received a notice that they allowed a one-time visit to this doctor whom they had ruled was out of network, despite the fact that I had confirmed with them previously that she was in network (and reconfirmed since). It goes on, but you get the idea. My point is: None of this is Obama’s fault.
As a person of mainly Irish heritage who grew up at the beach in the days before sunscreen, I also sometimes see a dermatologist. Before my last exam I thought it best, in an abundance of caution, to make sure the doctor I’d see was covered by my current policy. The insurance company’s website didn’t list the hospital-associated practice that I’d used for over 20 years, so I called the practice directly to see if they could confirm or deny that they took my insurance. They stated, unbelievably, that they didn’t know because “it’s all different now.” The insurance company, in turn, indicated that the listing of dermatologists on its web site was out of date and began reading me an alphabetical list of names over the phone. This is not Obama’s fault.
Several years ago, under a plan purchased as an individual through the pre-ACA Massachusetts marketplace (Romneycare), I had my first and, fortunately, only kidney stone attack. Taken by ambulance from Provincetown to Cape Cod Hospital (which is long way when you feel like someone is stabbing you in the abdomen with a knife), I was treated and paid the amounts not covered by insurance. Several months later, I got a call from a very aggressive and abusive collection agent. One of the doctors had not been paid because he had sent the bill to an incorrect address. Then, apparently without any attempt whatsoever to find my address (which is available on the Internet) or that of my insurance company, he immediately sold the claim to a collection agency in New Hampshire. This is also not Obama’s fault.
Our medical and health insurance bureaucracies are a complete mess. My heart goes out to the many talented and devoted doctors, nurses, and other practitioners and support staff who deal, every day, with the kinds of issues I’ve described here. (I have more.) But I wish we would be careful not to falsely assign blame for these problems to the ACA, though I fear it is too late now.
You can repeal Obamacare, but the chaos that is our health care system and medical insurance industry reigned long before Barack Obama became president, and it will continue long after Congress does whatever it’s going to do next. Some people won’t have access to health insurance that have it now, and some people will be financially ruined because their pre-existing condition will no longer be covered. But the eye exam will still be billed as outpatient surgery, and the ER doctor will still send the bill to the wrong address. Repealing the ACA won’t fix those things. What it will take to fix them is a commitment on the part of the health care bureaucracy and the health insurance industry to better manage their respective organizations. But I’m not holding my breath; that would be bad for my blood pressure.
Peter O’Connor, a former deputy secretary of the Massachusetts Department of Transportation, is a lawyer and consultant based in Boston.