Insurance shenanigans in the modern age

[pameladean]

I 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

Comments

[carbonel]

I don't know that it's any comfort, but I've been with Park Nicollet since 1990, and I've been reasonably happy with them. And I only had insurance problems with them once. Of course, that was the time they made me wait a few hours for an appointment the morning after the night when I'd broken two ribs on the basement stairs in the process of not tripping over Gandalf.

[pameladean]

I was with them myself in the 1990's, and I got a lot of very high praise for them in the comments when I did a post last year about choosing an insurance plan; that's why I went with HealthPartners, even though I still hoped I could stay with my original clinic.

I forgot to mention that they still had me in their records from the 1990's. They asked if we were still living on Minnehaha Avenue.

P.

[graydon]

There's a lot wrong with OHIP[1] but this sort of thing leaves me wondering why there aren't a whole lot of bodies dangling from lampposts every time someone in the US posts about it.

[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.

[pameladean]

It's still SO MUCH BETTER than it was before, is the thing. This is how they get you.

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.

[kore]

Oh, now that's good! I like places that keep their records.

Otherwise, what a fustercluck, though. And WTF why was it so impossible for them to just let you tell the doc "I didn't like the side effects so I stopped taking this"?

[graydon]

That's remarkably evil.

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.

[sovay]

I got an automated message from MyChart saying that my appointment of today had been cancelled. The reason given was "scheduling error."

Well, they don't have a drop-down menu option for "dumpster fire."

[carbonel]

My current dental insurance pays for about 50% of a crown, but I don't think it distinguishes what part of the procedure it's covering. The annoying part is that there is an annual maximum of coverage -- I think it's currently either $1K or $1.5K. In any case, it's only May, and I'm about to max it out, and the dentist says that two more crowns are fairly urgent. (I think there are five total left on the list.)

Grump.

[inlaterdays]

Wow, that's awful. I hope your appointment on the 18th goes well. And I'm glad that you figured out what was causing the symptoms and were able to stop taking the medication.

[eac]

It is deeply, deeply aggravating that Americans have to go through this must administrative torture just to see their doctors.

[pameladean]

Yes, this beats, I think, the library I visited in about 2010 that knew I'd lost a couple of astronomy books in 1991. (I paid them for it when they told me. I knew I'd returned a bunch of books very late but didn't realize I'd actually lost any.)

The doctor system at my now-previous clinic is a little odd; my doctor just kept falling off the list no matter when I last saw him. MyChart usually works better than that. I suspect that they wanted to try to sweet-talk me into starting the statin again, or trying another one, or a reduced dosage, because some doctors are very gung-ho on the glories of statins. I hope the new one isn't.

P.

[pameladean]

Yes, one's mouth (and eyes, for that matter) are not independent systems functioning separately from the rest of the body.

"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.

[pameladean]

Urgh. Quite apart from the monetary aspect, that's way too much dental work in just a year to be comfortable.

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.

[pameladean]

A sad omission indeed! Maybe I should suggest they add one.

P.

[pameladean]

Thank you! The new doctor sounds pretty compatible with me, so we'll see.

P.

[pameladean]

And that some other Americans like it that way.

P.

[kore]

Clearly that library had its L-space well-organized. wow!

I suspect that they wanted to try to sweet-talk me into starting the statin again, or trying another one, or a reduced dosage, because some doctors are very gung-ho on the glories of statins.

*eyerolls forever* Yeah, one thing I've seen in doctors -- regular doctors -- is they're no more immune to the changing whacky news in healthcare than anyone else. Cut carbs! Cut all your carbs! Take statins! No, don't take statins! Statins don't lower cholesterol but they do cut heart attack risk! High cholesterol does lead to heart disease! No it doesn't! Up down, inside out, whatever. I see it go thru the psychiatric circles too -- one year my bipolar friends are encouraged to take Abilify, or Emsam, or how about Ecstasy or microdoses of LSD? I think it's because all the scripts are being written based on short-term studies, and it's not til like decades later you get the longitudinal double blind stuff that definitively rules something in or out.

....oh dear this all sounds so cynical, whoops. I hope for good things from your next visit, and that they listen to you re the side effects!

[kore]

or "TOTAL FAIL"

[graydon]

Perhaps the horrid denizens of the legislature shall contract severe cases of irony.

[dreamshark]

"I suspect that they wanted to try to sweet-talk me into starting the statin again, or trying another one, or a reduced dosage, because some doctors are very gung-ho on the glories of statins. "

Or they wanted to make sure you aren't in the population where stopping statins abruptly can result in a heart attack. There is some evidence for this being a danger, although it probably depends on exactly what med you are taking, and how much, and how long you've been taking it.

Sorry to hear about the insurance fuck-up. You seem to be handling that part with more equanimity than I would. I have had very good experiences with both ParkNic and Health Partners, but I wasn't dealing with MNsure. It sounds like pretty much everything connected with Minnesota's failed attempt at creating their own ACA portal continues to be an unholy mess.

[dreamshark]

Dental insurance is, IMHO, a scam. It is not actually insurance at all, just some kind of half-assed pre-payment plan carefully weighted so the house almost always wins. The point of insurance is to pay for large, unexpected expenses, which is exactly what most dental insurance does NOT do. All the dental insurance plans I am familiar with have a very low annual payment cap (along the lines of $1800). And the premiums are outrageous for the amount of coverage they provide. Basically, the premiums just about cover cleanings and maybe one filling a year. Then there is a small window for larger expenses like crowns where they might cover half the cost of the procedure. And then you hit the cap and you're SOL. I find it hard to believe that these plans are even legal.

[dreamshark]

Nobody likes it that way. That's what's so aggravating. The people who insist on supporting the surreal lies coming out of Republican mouths have no idea what's going on, and unironically say things like, "Keep your government hands off my Medicare!"

[pameladean]

As best I can tell, that risk has only been studied in people who were admitted to the hospital with chest pain and actually had a heart attack. If they stopped statins after being discharged, their risk of a second heart attack was much greater. And also, yeah, the statin I'm taking was not represented in the study in statistically-useful numbers.

MNSure is actually fine now except that it is obviously understaffed and underfunded. I don't see any particular reason to blame MNSure rather than HealthPartners for the mix-up about Medical Assistance. MNSure's information about my plan has always been correct.

I might be more upset except that I am well aware that this could be the last year that I will have any health insurance at all.

P.

[pameladean]

At the moment I am finding cynicism very bracing. And yes, doctors are certainly susceptible to the latest fashion. I'm sure it's mostly with the best intentions, but that doesn't mean they give the best advice. And anyway, all such advice is statistical, and there will always be people who fall outside the numbers. I just hope to have that recognized fairly promptly when it happens. I guess we'll see.

The whole cholesterol circus must have been especially frustrating from you guys' perspective, what with people being paid by the sugar industry to toss out any study that showed sugar as culpable for cardiac events, and keep in any study that showed fat as culpable even if the studies had the exact same issues.

P.

P.

[pameladean]

I agree; I didn't mean them. I meant the Republicans who sabotaged the ACA and who are pushing to repeal it and replace it with garbage; and the donors who support them.

I mean, they're technically Americans, anyway, though if I felt like going around pronouncing on who the REAL Americans are, it sure wouldn't be any Republican legislator at all.

P.

[ethelmay]

States are required to provide dental benefits to children on Medicaid and CHIP. They choose whether to provide dental care to adults on Medicaid. Re adults, https://www.medicaid.gov/medicaid/benefits/dental/index.html says: "States have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. There are no minimum requirements for adult dental coverage."

Sad to say, that's better than I had assumed (which was basically that no one except kids got dental coverage on Medicaid).

[dreamshark]

Well, a lot of the early failures in the first 2 years of the MNsure system were reportedly failures to communicate effectively with the insurance companies that were supposed to be insuring people. This resulted in a lot of people being told by the MNsure system that they were insured, but they really weren't. I think most of those issues were corrected, but HP must have gotten the idea that you were on Medicaid from somewhere.

In any case, I hope it is cleared up quickly.

So far the only problem we've had with the HP Medicare plan is that it takes 3-4 months at the beginning of each calendar year for ParkNic to figure out that we owe co-pays. This results in being unable to pay them money we are pretty sure that we owe until all of a sudden we get a bill for everything in May that is already flagged as "past due." However, it doesn't seem to be "past due" enough to incur any extra fees or warnings, so no harm done. And this being the 2nd hip surgery, I knew there was a $400 copay so it wasn't a horrible shock.

[bibliofile]

AIUI Wisconsin's Medicare can include dental -- but good luck finding a clinic that both accepts Medicare AND new patients. I cracked a tooth and managed to find the one dentist in the county who took Medicare for emergencies only and saw me like the next day.

[lokifan]

Every single thing I hear about the US medical system makes me want to hug the NHS then jump in a lake. WTF.