Posted by: chlost | February 18, 2011

Bureaucracy-you can’t win if you aren’t in the game

It has been mentioned here several times that my mom is now living near me. She is 80 years old, and has had a lot happening in her life in the three months since she moved here.  In that three months, she has had two visits to the ER, has been hospitalized, then in a nursing home, then moved from the apartment she moved into on November 1st into an assisted living apartment. It has been quite challenging.

Now I am handling her finances. On the first day that she seemed lucid, I had her sign a Power of Attorney to allow me to handle her affairs. This includes paying her bills, handling her insurance, signing up for the apartment, dealing with the medical providers.

It is a full-time job.

Today, I spent time dealing with an insurance claim. She has a medicare insurer. There have been multiple claims over these past few months. One was not paid. I am trying to find out what the problem is, and trying to get it paid.

Now wouldn’t you think that the provider which has not been paid would cooperate with me, and do whatever they could to ensure payment? If you thought that, you would be wrong.

I spent over an hour on the phone, first talking to the provider. They told me the claim had been denied, and I needed to talk to the insurer. I talked to the insurer. They told me that they had no record of a claim for that date, and that the provider needed to resubmit the claim.  That sounded pretty reasonable to me. So, I called the provider again, and explained that they would be paid, if they resubmitted the claim. Or the provider could call an 800 number to discuss the issues around the claim.  Easy, right?

“No”, I was told. “The insurer needs to call us.”   I let the claims rep know that I was not impressed. I try to be kind, because I know that these people have crappy jobs, and it is not their fault. But really.  This is absolutely ridiculous. I am running interference for two companies with thousands of employees and billions of dollars. I am taking hours from my work day-a sole proprietor with zero billions. They can’t make a phone call to get their money?

Of course, in between the phone calls, there is the faxing of the power of attorney to verify that I even have the authority to play mediator for this issue. No one will even discuss the account without receiving this document. That is actually just fine with me-I am happy that they are complying with the confidentiality requirements for a patient. But it is additional time needed to try to resolve this.

Now it is Friday afternoon. The chances of anyone calling me back are zilch. I will not be able to get it resolved today. Next week I have my own work that must be done.

I am glad that my mom is not trying to deal with this. How could the elderly patients be expected to take care of these things? It is nothing that is her fault. She wouldn’t have a clue as to how to deal with it. I worry about those who don’t have family or friends to help them. And this is just one bill of many, many more that I will be handling.

Universal health care.

Now, what was the argument against it?  Really????

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Responses

  1. I feel your pain! I’ve spent this week dealing with bureaucracy (and have blogged about it) and it isn’t easy, I figure that I’m going to die from it when I get to be your mom’s age as there’s no one who would be willing to help.

  2. I’ve been a provider, a biller (preferred to do my own billing, rather than farm it out; worth it, as I had a 98% collection rate), a consumer (also known as The Insured), a daughter, and a complainer.

    What they want–“they,” being both sides of the issue–is for you to pay just to get rid of the issue. The provider benefits by receiving the payment with less hassle and a faster turn-around; the insurer benefits by receiving your mother’s premiums without having to dish out claims payments. It’s no accident; it’s policy.

    Now, who could possibly NOT want to change this SOP? How about the AMA, The American Hospital Association, the insurer’s federation, the pharmaceutical industry…everyone who benefits from something known as Usual and Customary charges. We consumers and responsibly charged children of consumers don’t have the big bucks to pay lobbyists.

    Universal health care? Makes the Egypt Answer look tempting, doesn’t it?


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