Insurance shenanigans in the modern age
May. 11th, 2017 09:25 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
pameladeanI was planning to do a photo essay about a recent visit to the Eloise Butler Wildflower Garden, and still plan to do one, but right now I feel impelled to write about health insurance. Not in the way that you may think. This year, David and I have insurance through MNSure, thanks to the Affordable Care Act. I am really grateful for having had insurance, and tax subsidies to help pay for it, for the past four years. And I want to dedicate this account, with an extremely unpleasant expression involving crossed eyes and a stuck-out tongue, to former Senator Joe Leiberman, who fucked up the possibility of a much better system than what we ended up with.
About a month ago I had several nights when I couldn't sleep because things in general hurt. I kept thinking that I must be coming down with the flu, but I never did. Then instead of a general achiness I started having specific muscle pains that couldn't in any way be correlated with unusual or even usual exertion. They came and went in no pattern and with no cause. Then I started feeling a really strange sort of dizziness. I can get postural hypotension from my blood pressure medication, but this was much weirder than that and, like the aches, didn't really correlate with anything.
An acquaintance posted on Twitter that her statin had been causing dizziness and brain fog. Wait, I thought, muscle pain can come from statins. I read the patient information sheet and stopped taking my Lipitor. I ought, of course, to have called the clinic and left a message for my doctor, but I was busy. I don't even have high cholesterol. I just have a 14% chance of some kind of cardiac event over the next ten years, according to some calculation the state of Minnesota does, because of the hypertension, type 2 diabetes, proportion of good and bad cholesterol, and possibly a few other things that I've forgotten. On the basis of this calculation I was advised to take a statin and daily low-dose aspirin. So I figured stopping the statin for a little while wouldn't do any harm.
Within 48 hours the aches and dizziness had vanished. On Monday I tried to send email to my doctor, but there wasn't an email button under his name in the list of my "Care Team" on MyChart. I could have emailed my eye doctor, the nurse practitioner I've seen for a few minor ailments, or the diabetes nurse who showed me how to use a glucometer. But they hadn't written the prescription. I finally scheduled an appointment with my doctor, since I'm due for a bunch of lab work anyway; and in the space left to explain why you want an appointment, I explained about the side effects and stopping the statin.
The clinic called and asked me to call back, and when I did the nurse I talked to asked if I would be willing to see a different provider so they could get me an appointment sooner than Thursday the 18th; and I was willing, so she scheduled an appointment for this afternoon.
When I arrived I went to the registration desk, and the clerk told me with every evidence of sympathy that the clinic was not in network for my insurance plan and they would have to cancel the appointment unless I wanted to sign a consent form saying I would pay out of pocket. She also said that I was enrolled in a HealthPartners Medical Assistance plan, which I knew I wasn't. MNSure checks this for you when you give them your income information, and we aren't eligible for Medical Assistance. So I hoped that if I could get this part straightened out maybe they'd let me have my appointment. I had been pretty sure that the clinic was not in network for my plan -- it is in network for some specialties like chiropractic services and chemical and mental health, which initially fooled me into thinking it was generally all right for my plan; but it's not in network for primary care. I'd been able to get my medications from the pharmacy all right, and I really didn't want to change clinics, so I hadn't done anything about it. I said I'd pay out of pocket -- I know about what they charge for visits and this was a short one; and I wasn't actually worried about the statin, but it seemed to have sent the clinic staff into a tizzy that I had stopped taking it without consulting anybody -- and then I knew I'd really have to change clinics.
So I signed the form and went upstairs, in the nick of time for my appointment; but the poor clerk came running up the stairs and caught me. Her supervisor had "come by" and said that no, really, I couldn't have the appointment. They were legally required to bill the insurance company, and then the claim would be denied because the clinic was out of network, and "that would be a problem." I didn't see any point in inquiring further into this; I could see many possible reaons that they would prefer not to be billing plans that would not pay them.
But, she said, she would take me to the office of the financial counselors, who would help me change my plan so that I could stay at the clinic. I was pretty sure that this would work only if I really were on Medical Assistance, but I went with her and explained my situation to the counselor when they called my number. The counselor said that there had been some kind of confusion with HealthPartners assigning a lot of people to Medical Assistance who weren't on it, and she had fixed that part of things in my records, but the clinic was still, really, out of network for my plan.
I walked home -- at least it was a lovely spring day -- and called the nearest Park Nicollet clinic and got an appointment with the doctor of my choice -- from a list I'd made in January before I got stubborn and busy and didn't follow up with the change of clinics -- for Thursday, May 18th. I didn't laugh at the very nice woman on the phone who was helping me, but I laughed afterwards. I then had to call my dentist and move a hygiene appointment from that date to the following Monday.
I got an automated message from MyChart saying that my appointment of today had been cancelled. The reason given was "scheduling error."
I'm sure the new clinic will be fine, but Joe Leiberman can go jump in some really nasty polluted lake.
Pamela
About a month ago I had several nights when I couldn't sleep because things in general hurt. I kept thinking that I must be coming down with the flu, but I never did. Then instead of a general achiness I started having specific muscle pains that couldn't in any way be correlated with unusual or even usual exertion. They came and went in no pattern and with no cause. Then I started feeling a really strange sort of dizziness. I can get postural hypotension from my blood pressure medication, but this was much weirder than that and, like the aches, didn't really correlate with anything.
An acquaintance posted on Twitter that her statin had been causing dizziness and brain fog. Wait, I thought, muscle pain can come from statins. I read the patient information sheet and stopped taking my Lipitor. I ought, of course, to have called the clinic and left a message for my doctor, but I was busy. I don't even have high cholesterol. I just have a 14% chance of some kind of cardiac event over the next ten years, according to some calculation the state of Minnesota does, because of the hypertension, type 2 diabetes, proportion of good and bad cholesterol, and possibly a few other things that I've forgotten. On the basis of this calculation I was advised to take a statin and daily low-dose aspirin. So I figured stopping the statin for a little while wouldn't do any harm.
Within 48 hours the aches and dizziness had vanished. On Monday I tried to send email to my doctor, but there wasn't an email button under his name in the list of my "Care Team" on MyChart. I could have emailed my eye doctor, the nurse practitioner I've seen for a few minor ailments, or the diabetes nurse who showed me how to use a glucometer. But they hadn't written the prescription. I finally scheduled an appointment with my doctor, since I'm due for a bunch of lab work anyway; and in the space left to explain why you want an appointment, I explained about the side effects and stopping the statin.
The clinic called and asked me to call back, and when I did the nurse I talked to asked if I would be willing to see a different provider so they could get me an appointment sooner than Thursday the 18th; and I was willing, so she scheduled an appointment for this afternoon.
When I arrived I went to the registration desk, and the clerk told me with every evidence of sympathy that the clinic was not in network for my insurance plan and they would have to cancel the appointment unless I wanted to sign a consent form saying I would pay out of pocket. She also said that I was enrolled in a HealthPartners Medical Assistance plan, which I knew I wasn't. MNSure checks this for you when you give them your income information, and we aren't eligible for Medical Assistance. So I hoped that if I could get this part straightened out maybe they'd let me have my appointment. I had been pretty sure that the clinic was not in network for my plan -- it is in network for some specialties like chiropractic services and chemical and mental health, which initially fooled me into thinking it was generally all right for my plan; but it's not in network for primary care. I'd been able to get my medications from the pharmacy all right, and I really didn't want to change clinics, so I hadn't done anything about it. I said I'd pay out of pocket -- I know about what they charge for visits and this was a short one; and I wasn't actually worried about the statin, but it seemed to have sent the clinic staff into a tizzy that I had stopped taking it without consulting anybody -- and then I knew I'd really have to change clinics.
So I signed the form and went upstairs, in the nick of time for my appointment; but the poor clerk came running up the stairs and caught me. Her supervisor had "come by" and said that no, really, I couldn't have the appointment. They were legally required to bill the insurance company, and then the claim would be denied because the clinic was out of network, and "that would be a problem." I didn't see any point in inquiring further into this; I could see many possible reaons that they would prefer not to be billing plans that would not pay them.
But, she said, she would take me to the office of the financial counselors, who would help me change my plan so that I could stay at the clinic. I was pretty sure that this would work only if I really were on Medical Assistance, but I went with her and explained my situation to the counselor when they called my number. The counselor said that there had been some kind of confusion with HealthPartners assigning a lot of people to Medical Assistance who weren't on it, and she had fixed that part of things in my records, but the clinic was still, really, out of network for my plan.
I walked home -- at least it was a lovely spring day -- and called the nearest Park Nicollet clinic and got an appointment with the doctor of my choice -- from a list I'd made in January before I got stubborn and busy and didn't follow up with the change of clinics -- for Thursday, May 18th. I didn't laugh at the very nice woman on the phone who was helping me, but I laughed afterwards. I then had to call my dentist and move a hygiene appointment from that date to the following Monday.
I got an automated message from MyChart saying that my appointment of today had been cancelled. The reason given was "scheduling error."
I'm sure the new clinic will be fine, but Joe Leiberman can go jump in some really nasty polluted lake.
Pamela
no subject
Date: 2017-05-12 04:10 am (UTC)[1] wretched tendencies to use money as a metric of health outcomes; a refusal to set taxes by the service level; letting people with business degrees run hospitals; a certain bureaucratic opacity on the government side. And there's stuff that's not covered (such as optical or dental). But if you've got your health card that's pretty much that.
no subject
Date: 2017-05-12 04:52 am (UTC)Standard plans on the marketplace here don't include routine eye care or dental care either. You can get separate dental insurance, but it's stingy and sneaky and evil. When I had it, it would pay for a crown, but not for prepping the tooth to receive the crown.
P.
no subject
Date: 2017-05-12 05:05 am (UTC)Dental insurance here has a rate list, which is fixed by ... regulatory negotiation, let's call it. It covers everything because the dentists really don't want to get pulled into single-payer. (Though every time some kid dies of an abscessed tooth there's a general call to start covering dental, which I think would be wise. Especially since there's all those indications that dental plaque and arterial plaque are the same stuff.)
May Medicare for all not be long in coming.
no subject
Date: 2017-05-13 03:47 am (UTC)"May Medicare for all not be long in coming." So say we all.
Governor Dayton is trying really hard to put through MinnesotaCare for all, but there are way too many horrible Republicans in the legislature.
P.
no subject
Date: 2017-05-13 12:00 pm (UTC)no subject
Date: 2017-05-13 06:41 pm (UTC)no subject
Date: 2017-05-13 09:36 pm (UTC)Sad to say, that's better than I had assumed (which was basically that no one except kids got dental coverage on Medicaid).
no subject
Date: 2017-05-18 07:10 am (UTC)no subject
Date: 2017-05-12 03:20 pm (UTC)Grump.
no subject
Date: 2017-05-13 03:49 am (UTC)My dentist showed me the breakdown; it was fiendishly clever. But they may not all do that.
An annual maximum is so maddening. If you aren't worried about going over it, you're trying to get your money's worth even if you may not really need to. It's all so very stupid.
P.