I know that we are supposedly giving up on a single-payer system. The "compromise" seems to be that at least we'll get a public option. But IMHO, one of the largest money-sucks in the current system is the whole issue of the coordination of benefits (COB). It is a bureaucratic nightmarish broken system where "mistakes get made" that end up costing me, the companies, the billing office, time and money, and thus waste health care dollars.
So this is a diary about how the coordination of benefits between plans has sucked my time, created stress and work for everyone, ends up being my responsibility through no fault of my own, and how a single-payer system is needed in order to cut out the enormous time toll taken by everyone dealing with the coordination of benefits. Mine is a story which is probably repeated across the country many times and must lead to lost productivity on the part of clients and insurance companies. If we want to find waste in the health system, here's a good place to look.
I'd been on my husband's health plan since November 2003. Me and the two kids. Hubby an I were both employed by the same employer (the University of Wisconsin-Milwaukee), who only allowed one family plan. So the family's on the husband's plan (let's call it the Heifer Company).
Lo and behold, I find a new job that pays more than an Associate Professor, in the middle of a tanking economy, take it, and now our family has second coverage (BlahBlah Company in Illinois). (Yes, unfortunately the job is in another state, but with the help of Amtrak we're making it work. Although I miss my kids. But I digress.)
The second coverage kicks in on February 1st 2009. I dutifully do my duty and inform Heifer of the existence of BlahBlah. The husband and kids, now have Heifer as primary and BlahBlah secondary. BlahBlah is primary for me, because I'm the policy holder (Heifer remains secondary). With me so far? Now it gets good. Some time about May I begin getting coverage rejection letters from Blue Cross for coverage. Odd, I think, I haven't seen any doctors lately.
It turns out as I look more closely that the rejection letters are for dates of service from BEFORE I even had Blahblah -- '08, '07, --services that had long since been paid for by Heifer. In tandem I then start getting bills from providers for those same dates of service.
So I call one of the providers and ask why they are billing me for services already paid for. They tell me that Heifer's Cost Recovery Unit (love that name, don't you?) had contacted them and asked for repayment, because their (Heifer's) records show that I had other insurance (BlahBlah) at the time of service. So, the provider sent the money back to Heifer, sent a claim to BlahBlah who in turn rightfully told them that I was not insured by them in 2007, 2008, and rejected the claim. So the provider is now billing me.
I call Heifer and, oops!, yes, someone at Heifer had input the incorrect start date for BlahBlah - ha ha, as November 2003. So in kicks Heifers Cost Recovery Unit and goes back and asks for its money back from providers it had already paid. I need to talk to the COB office and get that changed! (When I point out that the Cost Recovery Unit had made a mistake that is actually going to Cost Heifer Money to straighten out, they don't see the irony.)
My next call is back to the provider, and tell them of the incorrect date entry that had been made by Heifer. I inform the provider that I've talked to the COB office at Heifer, and that I've been assured that the prior claims will be re-processed, but don't hold your breath. I'm sure this will be a nightmare.
And then I can't help but ask "why did you give Heifer its money back?" I mean, I just don't get it, I'm dumb. You mean that when an insurance company asks for money back, you don't question it? Ask why? Contact the patient first? Just to maybe save yourself some hassle? No, no, I'm told. If they ask for it back, they get it. Why? I ask. Is it a company policy? A state regulation? A requirement to be part of the network? What? Why? Of course, no one can tell me why.
Needless to say I am still in a viscous circle with Heifer and the providers, and getting nasty overdue letters from the providers. I want to write them back and say, look don't call ME a deadbeat. You're the jerks who gave them back their money in the first place.
Ahh, but this situation is nothing, absolutely nothing compared to the nightmare I went through in 2001. At that time I held the family policy in Wisconsin with BlahBlah, took a partial leave of absence to again work in Illinois. The fact that the leave was partial allowed me to keep my insurance in Wisconsin. But I was also afforded health insurance with BlahBlah at my new job in Illinois. So in fact I was the policy holder for both our primary insurance (in Wisconsin) and the secondary insurance (Illinois). Ahh, you might be thinking, COB heaven - the same company! So easy! Coordination of Benefits - a snap!
But you'd be dead wrong. It turns out that since I was the policy holder for both policies, it was actually impossible to electronically coordinate benefits across state lines. Why? Because at the time they were using social security numbers as account numbers, and the computer networks refused to the same SSN from two different policies. It took nearly six months and (I logged it) 23 phone calls before someone could identify the problem. But then they had no idea what to do. Six weeks and nine calls later, they finally had a computer tech dummy up an Illinois number. But then all claims had to be re-submitted with new policy numbers. Oh, the providers were really glad to do that. And I again, was really happy to track all the dates of service and make sure the claims were re-submitted and lo and behold if some of them didn't go to collection ....
I know my nightmare COB story is nothing compared to the stories of people without access, with rescinded access, denied access. But it is emblematic of the way the system is focused on insurance companies instead of patients, on productivity losses sucked up by this sector, of the needless time and effort so many more than just me have had to spend to get these companies to do the right thing.
Multiple insurance companies with endless coordination of benefit issues has got to go. We need single, seamless single-payer if we want to realize any health insurance efficiencies.