Insurance & Other Matters

I've been home two weeks, and it has been great. Family life has a rhythem again. I am getting stronger each day. My intestines are beginning to work more effectively. I've been able to work thru my emails. And I'm starting to do some grant work from home. Plus, I've gone to some of my favorite haunts in Holland and Saugatuck for breakfast and lunch.

Another thing that is taking a significant amount of time is trying to decipher my insurance explanation of benefits (EOB) in comparison to the invoices I have received from the University of Chicago and UPMC. Please know this is not a 'bitch' session, but a reality of trying to figure out who I need to pay for services.

As an example, I have three insurance EOBs from my June hospitalization at UChicago that show a bill was submitted by UChicago and paid by insurance at 100%. Then I get a bill by UChicago that shows the bills were not paid by the insurance company, and that I owe 'X'. Huh?

So earlier this summer I called UChicago and they said they would look into it. Last week, I got a second notice that I owed 'X'. I called UChicago again. Now, they are suggesting that the insurance company hasn't paid anything for those services; so I should call my insurance company. Huh? I have an EOB.

I know I am not the only person who goes through this, and really our insurance company has been pretty good. We don't have a lot of these situations. But, the entire thing makes me think of the administrative costs we have in the USA insurance system. If we multiply the paperwork time needed to write the claim, submit the claim, review the claim, pay the claim (or not pay it), argue about the claim and then multiply that amount by salaries, profit margins, ya-da, ya-da, ya-da. And you get a lot of costs on top of the technology advances, new medicines, etc.

It all calls out for reform, which we are in the process of with the Affordable Care Act and everyone complains about it. I say like they do in the NFL pregrame shows - C'mon Man.

Something needs to be done to slow down the growth curve in health care. Part of it for me is that we need a system that puts some responsibility back on the individual. Whether it is a minimum deductible, a percentage that everyone has to pay for their benefits, a requirement to buy insurance, or a tax penalty if you don't buy insurance there needs to be a financial buy in. Our society is too unhealthy not to put some onus back on the individual. (Can we say obesity epidemic!)

And the idea that we scrap the ACA before it is tried is silly. I was at a conference this year in DC, and the presenter pulled an op-ed by the Heritage Foundation from the early 1990s about health care reform. The Heritage Foundation suggested the idea of a health care exchange. (Just so you know - that is in the ACA.) They also talked about incentives and penalties (like buying insurance or paying a tax penalty). This entire critique of the ACA as 'Obamacare' is not serving our country. It is intended to divide instead of finding common ground.

Look, I'm not naive enough to think that the Democrats didn't push through healthcare without effectively getting bipartisan support. But at this point, we need to do something. I've been in the system (a lot over the past three years) with great health insurance from two providers and sometimes I find that the health care system doesn't make sense. Let's see how the ACA plays out (assuming the Supreme Court doesn't throw it out) and continue reforming. With the Baby Boomers starting to draw on Medicare, my generation needs some help slowing the curve, or we will never be able to pay for the care of our parents.