Monday, October 30, 2006

Wrong Number

I'm sorry. The provider you have reached is not in network.

If you would like to make a different choice, press 1.

If you want to stay with this provider, press 2.

If you are totally confused, press 3.

All other calls will be re-routed to voice mail where someone may eventually retrieve your message and attempt to call back during hours that are convenient to us.

Have you ever wanted to know what a 60-mile helicopter rescue costs?

Actually, I haven't.

The first helicopter brought a deputy from Chelan County. The second brought paramedics and a gurney, and I was instructed to board. One of the paramedics asked if I had good insurance.

"We'll see soon enough," I said prophetically.

Within an hour, I was in an emergency room in Central Washington Hospital in Wenatchee. X-rays showed a distal fracture of the left fibula. The rest of the story is inopportune and tiresome, but a week later I was home.

Then I got the invoice. Answer: $10,000.

$10,000 for a 60 mile helicopter ride isn't a bad deal. Some folks are billed that much for a 4 mile ride.

Jane and I are fortunate enough to be gainfully employed, and we're insured by Anthem through Jane's job at Virginia Tech. Anthem wants to pay $4,000.

Not getting too technical here, because, frankly, I'm still mystified, but I'd been caught in the particular anguish termed "out of network."

Fortunate. I hate that term. It implies folks get treated differently in life, not because of hard work but simply the luck of the draw.

Out of network. Hidden providers. Watch them get soaked.

It works like this. Insurance companies partner with providers (the network) and pay them a predetermined amount for various services. If you have treatment by a nonpartner, your insurance company will pay less, unless you have opted for a special "out of network" premium, which will pay an equal amount in case of emergency

Unless they have an HMO, that is not the way it works, but why quibble?

That out of network premium by the way is usually done by opting for an indemnity plan.

But here's the kicker: nonpartner providers can charge virtually anything they want, unburdened by predetermined fees. Because Anthem never partnered with my helicopter company, I got shafted

Most medical transport companies are not part of ANY network.

I had a client ask about ambulance coverage the other day. When I explained that the reimbursement will be less for ambulance transport and he may have some out of pocket he had the perfect solution.

"If I have a heart attack I will just drive myself to the hospital rather than paying for an ambulance."

Good choice. Just what we need. A guy having a heart attack driving his car.

The unfairness of this situation is clear and indicative of the mess we call today's American health insurance system. The overarching issue is whether we consider the miracle of modern medicine a birthright to all citizens or only those with the financial wherewithal to participate, which is fodder for another essay.

Uh-oh. Left wing alert.

But when Jane and I have spent upward of $25,000 on premiums over the last decade to protect us during such emergencies and we're only reimbursed at 40 cents on the dollar, something is wrong.

Where is the political will to fix it?

Political fix.

Yes, that's the ticket. The government does such a fantastic job of managing OUR money, let's just let them intervene even more.

Actually he had the answer already and mysteriously overlooked it. He could have paid EXTRA to have out of network cover. A political fix is not necessary. He just wants to blame someone else.
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