Monday, September 27, 2010


Today at work I got a phone call from a Patient that wanted to discuss his Insurance bill. Usually this means two things...

1) They have NO IDEA how insurance works
2) They just want to find a way out of paying their balance

This guy just wanted to BITCH about the "high mark up" of health care AND he has no clue how insurance works. Not a good combination. The conversation started out edgy, only to turn down right vicious within minutes as I tried to explain how he has a "co-insurance" for his services rendered from our Doctor. He didn't want to hear it. All he did was SCREAM at me, telling me how wrong it is that "we" charge so much for our services. All I could say was how WRONG it was that insurance companies determine what is REASONABLE AND CUSTOMARY and STILL adjust a HUGE portion of billed service according to the "contracted rate." He just didn't get it. He thinks the provider of service is the bad guy (our doctors) when in reality, its the Insurance companies that are EVIL. 37 minutes I had to spend on the phone with this guy, breaking down every charge, every insurance payment made, every adjustment WE took, every balance he owed to our practice and why. His total amount due? $140.

A quick look into his account was something like this....

We charged $150.
Insurance paid $37.62 per our contracted rate with them.
Which meant WE WRITE OFF $107.27 of our charge!
Which means the patient is left to pay his co-insurance of $5.11

This guy hasn't paid these small co-insurance portions for MONTHS on multiple dates of service which leaves him with a $140. I, being the TOTALLY UNDERSTANDING PERSON I AM BECAUSE MY OWN INSURANCE SUCKS, have not turned him over to collections like I *should* have months ago because....Well, because I think its wrong to turn someone over for medical debt unless they OBVIOUSLY refuse to pay.

So anyway....I understand his frustration, really, I do. But people need to stop blaming the Medical providers and turn their fight against insurance companies. As he bitched and complained about paying "this" for "that" my blood boiled. My CGM alarm was ticking me off, alarming LOW BS over and over. I was 72. I must have silenced the alarm 10 times in that very long 37 minute bitch fest of torture from this guy.... Which reminded me....would he REALLY like to know what sucks?

How about the fact that some people don't have insurance? How about the fact that some people haven't been able to get AFFORDABLE insurance because of Pre-existing conditions? How about the fact that COBRA coverage is RIDICULOUS and has put our family along with thousands of others in serious debt because the premium is comparable to a mortgage payment? I was wasting my breath on this guy. I could explain all day, and he just wouldn't understand. Half listening to this crazy man I just wanted to SCREAM. I mean, really. When I think about our own families financial issues because of health insurance....because of Diabetes......I just about flip out. I imagined myself shouting back at him....

"""Do you know what I pay for our life saving Insulin because our Rx coverage sucks!!?? $160 bucks TIMES TWO per MONTH mister jackass~!!PER MONTH! Do you know why? Because our INSURANCE PLAN doesn't cover name brand medications!! We used to pay $10 a month....but lose a job, get shitty insurance, and now we pay $160 for insulin!!?? You want to bitch about your $5.11 here and there from over the last 6 months that you haven't paid!!?? REALLY?

Would you like to know that your insurance coverage shows SUPERIOR to mine? Superior to SO many people? 20 finger pokes a day in my house MISTER JACKASS...thats $20 a day for test strips without insurance!! Can you do the math? That's $600 a month to draw blood from our fingers!! And pump supplies? Do you want me to tell you about THAT Mr Jackass? In our house we pay 40% of our insulin pump supplies. TIMES TWO. That's about total to a monthly car payment if ya didnt know. If my insulin pump breaks...UM...YEAH That's 8 GRAND PLEASE!! And lab work? ummmmm.....Lets see....our new SHITTY insurance plan gives me a coinsurance for THAT too! I have never head to pay coinsurance for lab work, but guess what!!?? We do now! (I couldn't even discuss IP services) God forbid if one of us in this house ends up in the hospital"""...... OHHHHHHHH the things I wanted to tell this guy.

$140. Seriously? I bit my tongue for 37 minutes. As ticked off as I was at him AND Diabetes at the moment, I did very well.... I killed him with kindness and spared him the WRATH OF WHAT I REALLY WANTED TO SAY!

I didnt treat that 72 blood sugar as my CGM alarmed. Post 37 minute phone call with MR JACKASS and my CGM read 162. FABULOUS.


Hallie said...

Oh, Kelly. Hugs. I'm so sorry! I hope he sits on a tack - or really something worse that I can't write here!

Heidi / D-Tales said...

I can imagine how difficult it must've been to maintain your professionalism. Jerks like that don't know how good they've got it. Your insurance coverage sounds similar to ours. We pay out of pocket for all of Jack's diabetes supplies and doctors's visits, meds, tests, labs, etc. for the rest of us, and our monthly insurance premium is enormous. It sucks! We could own a second home and have another mortgage for what we pay in medical expenses each month! What I wouldn't give to get coverage like that which Mr.Jackass has! Total Jackass!

phonelady said...

All I can say is amen sista !!! This guy obviously does not want to be reasonable or hear any of what we go through on a daily basis.

Lora said...

Deep breath!! BTW: That's a whole lot of $5.11 unpaid co-ins to reach that much. I think my doc would have stopped seeing me by now.