A personal experience with health care insurance.

Because my former employer, AT&T, hiked the monthly charge for my insurance carrier, US Health Care, from $141 to $291, I switched to another AT&T provided option for 2010: HIP New York. Monthly cost: zero. There were some minor differences: $50 for a specialist visit as opposed to $40; $50 deductible for prescription medicine, which would be $30 per 90 days instead of $20. Nothing that would justify paying almost $300 per month. Once again, my increase was OVER 100%. Obama was dramatizing the recent 39% increase in California. Hey, 100% is more than twice 39%! With US Health Care I could go to a specialist directly without getting a referral from the primary care physician (PCP). HIP New York requires that I get a referral from my PCP. So far I have not tested this. All my specialists took HIP New York but my PCP did not, so I would need a new PCP. HIP New York seemed to be a good choice. My old single practitioner PCP is a good doctor but his office administration was terrible. Usually, I could not get anyone on the phone, I could not leave a message and his office hours were limited. Having prescriptions sent to Medco (designated by AT&T) for mail order was a continuing source of concern and frustration. I chose Westchester Medical Group, which had many doctors in multiple locations AND a web site in which I could review doctor credentials and make appointments, request referrals, submit billing questions, review test results. http://www.westmedgroup.com/ Impressive, heh? Wow, this seemed like a major improvement if my new PCP was comparable to my previous PCP. My new PCP is good but he is old and apparently he does not use his group's web site. There were issues about simple gastro medicine. He seemed unaware of Medco's mail order system and told me that he just writes prescriptions that patients take to the local pharmacy. How quaint. I insisted that I wanted mail order because it is less expensive and more convenient. He was not sure that his people knew how to submit a prescription to Medco but his nurse assured him that she did. When the Westchester Medical Group, Medco and HIP New York web sites did not mesh on the status and details of my prescription I sent a message through the Westchester Medical Group web site expressing concern, thinking that it would be handled by an admin person. I received multiple phone calls from my new PCP about this. My PCP became agitated, stating that he was just trying to practice medicine and that neither he nor his people would spend hours on the phone trying to resolve this .. and that I should call and not send e-mail. Let's just say that there were more problems and that they need to be resolved, including his switching me to a new non-generic gastro medicine that HIP New York does not classify as continuing, which limits the supply to 30, not 90, days. This medicine appears to be the usual drug company trick of creating a slightly newer medicine when its predecessor is about to go generic. The new med, of course, costs a lot more than the old. My PCP fell for it. February 5, 2010 my new PCP performed an endoscopy on me. A couple of weeks later, I received a bill for $1,050 from the anesthesiology group. They claimed that they did not have any insurance info on me. Say what? Didn't Westchester Medical Group and/or my PCP pass along that info through the hospital? I had to show my HIP New York card at the hospital. Again, how quaint. Suppose that I had lost the plastic proof of insurance? Next I received a bill from a pathological organization, which I assume is the business for the hospital pathologist. After calling that group and HIP New York I learned that HIP New York had paid only $116 of the $330 submission and I was asked to pay the remaining $214. HIP New York informed me that the doctor in the hospital pathology department was not "in network". I asked what pathologist for that hospital would be "in network". HIP New York did not know. HIP New York will re-submit the claim of the pathologist but stated that it would probably be rejected again. What the heck? I had no control over who did the pathology work. I never even heard of this pathologist until I received the bill. At least I had met, though not chosen, the anesthesiologist just before my procedure. Suppose the anesthesiologist had not been "in network"? Could I have been socked with that $1,050 bill? I understand why some members of Congress are against a single payer system for health care: some of it is philosophical but most of it is greed. What I cannot understand are all those regular people who are foaming at the mouth in opposition. Don't they have experiences that are comparable to mine? I am relatively healthy. What the heck are sick people going through? Separate health care from insurance. Have the federal government pay the bills. And if the government will not pay the entire amount, present patients with clear indications of how much they will be expected to pay BEFORE medical work is done. ____________________________________________ Sent to Paul Krugman (New York Times), President Obama, Senator Charles Schumer, Senator Kirsten Gillibrand, Rep. Nita Lowey