14 May 2011
03 May 2011
16 March 2011
17 January 2011
12 January 2011
07 January 2011
12 December 2010
05 December 2010
Health Care on a Personal Level
Back in June I had a medical procedure performed. I was having some gastrointestinal issues and my doctor recommended having an EGD (esophagogastroduodenoscopy) - essentially they put a scope down my stomach to determine what the underlying issues were. To make a long story short they found some lesions in my stomach (pre-cursors to ulcers). They put me on some medication and my symptoms have subsided for the most part. I was generally happy with this part of my experience
My experience with my health insurance is a completely different story. First and foremost, I was told by my doctor they could only perform the procedure at a facility located an hour from where I live (about 40 miles). The facility where my doctor visits take place and where they perform these procedures was out of network. The doctor, of course, was in network but the facility was not. Thus, to have the procedure covered by my insurance we had to go to the other facility.
About a month after the procedure I started to receive statements from my insurance company indicating which bills they paid, and what they did and did not cover. Everything was covered (except for co-pays and such): the doctor, the pathologist, the facility, but not the anesthesiologist. According to the insurance company he was out of network. What? How could that be? I thought that I had traveled out of my way an hour to go to a facility that was in network? That's where my thinking was wrong; the facility was in network but the anesthesiologist was out of network. How could I have made such a poor assumption? When I inquired my doctor's office about what seemed to be their error, their nonchalant response was: "that's unfortunate your insurance isn't covering the anesthesiologist, but it's your responsibility to cover any cost that your insurance doesn't." Evidently, just prior to sedation, I'm supposed to ask the anesthesiologist whether he's in network or not.
Once I received the bill ($490) from the anesthesiologist I submitted a claim to the insurance hoping that their denial was a mistake. It was not. Again I received a letter stating that they could not cover the bill per the out of network status. Next I took my complaint to my human resource representative hoping that they may have some pull. They said that they would see what they could do. At the same time I sent a letter to the anesthesiologist asking for a discount on the services provided. To their credit they gave me a discount of $245. Unfortunately the HR rep could not get the claim pushed through and after a third attempt the claim was again denied.
So here I am stuck with a $245 bill that I've fought 5 months and don't want to pay. We live in the country with the "best health care in the world", so I must have done something wrong. But no I didn't. I paid my health insurance premiums, and went to a provider who was in network. But in a health care system that is so convoluted and confusing that doctors can't even figure out I am screwed because one facet of the procedure was out of network. I must pay the bill or risk having it go against my credit. Eventually I'll pay the bill but not without complaint.
My experience with my health insurance is a completely different story. First and foremost, I was told by my doctor they could only perform the procedure at a facility located an hour from where I live (about 40 miles). The facility where my doctor visits take place and where they perform these procedures was out of network. The doctor, of course, was in network but the facility was not. Thus, to have the procedure covered by my insurance we had to go to the other facility.
About a month after the procedure I started to receive statements from my insurance company indicating which bills they paid, and what they did and did not cover. Everything was covered (except for co-pays and such): the doctor, the pathologist, the facility, but not the anesthesiologist. According to the insurance company he was out of network. What? How could that be? I thought that I had traveled out of my way an hour to go to a facility that was in network? That's where my thinking was wrong; the facility was in network but the anesthesiologist was out of network. How could I have made such a poor assumption? When I inquired my doctor's office about what seemed to be their error, their nonchalant response was: "that's unfortunate your insurance isn't covering the anesthesiologist, but it's your responsibility to cover any cost that your insurance doesn't." Evidently, just prior to sedation, I'm supposed to ask the anesthesiologist whether he's in network or not.
Once I received the bill ($490) from the anesthesiologist I submitted a claim to the insurance hoping that their denial was a mistake. It was not. Again I received a letter stating that they could not cover the bill per the out of network status. Next I took my complaint to my human resource representative hoping that they may have some pull. They said that they would see what they could do. At the same time I sent a letter to the anesthesiologist asking for a discount on the services provided. To their credit they gave me a discount of $245. Unfortunately the HR rep could not get the claim pushed through and after a third attempt the claim was again denied.
So here I am stuck with a $245 bill that I've fought 5 months and don't want to pay. We live in the country with the "best health care in the world", so I must have done something wrong. But no I didn't. I paid my health insurance premiums, and went to a provider who was in network. But in a health care system that is so convoluted and confusing that doctors can't even figure out I am screwed because one facet of the procedure was out of network. I must pay the bill or risk having it go against my credit. Eventually I'll pay the bill but not without complaint.
22 November 2010
20 November 2010
26 October 2010
21 October 2010
20 September 2010
29 August 2010
17 August 2010
28 July 2010
27 July 2010
17 July 2010
Money Hungry ESPN
For the first time in 150 years of the British Open, the coverage will be broadcast entirely on cable TV. This comes at a time when people are trying to cut back on expenditures. Traditionally, the first two rounds of the tournament are broadcast on cable TV, then for the final two rounds coverage gets put on the regular networks, usually CBS, NBC or ABC. For the British Open, coverage during the week is usually on ESPN and then switch to ABC for the weekend. ESPN has decided not to continue with tradition and lock people like myself out of the coverage. Because I am a graduate student and my family, with a stay at home mom, survives entirely on my salary, we just have basic cable, which does not include ESPN. Presumably they make more money restricting coverage solely to their cable network. Ok, of course they make more money. But don't they miss out on getting greater ratings, with more viewers, by showing it on ABC as well? This is especially true considering the tournament this year is being played at the home of golf, St. Andrews golf club. This gives the impression that the cable networks are all about money. And how they can make more of it. Over the years coverage on regular TV networks has become more and more limited. We see this with the NBA playoffs - all games are broadcast on TNT or some other network until the finals. Most people have cable with dozens of channels, but a portion of the fan base miss out. But it's not about the fans it's about money. Should we expect anything else from a corporation? Perhaps not, but then again our court systems have continued to rule that corporations have the same rights as individuals.
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