Friday, January 20, 2017

THAT's not the problem.

I usually stay away from posting about politics on Facebook and social media.  My liberal views are pretty evident given the information I share or the posts that I support, but I have chosen to live a quiet, neutral virtual life as I have family, friends, and acquaintances from all walks of life, with varied and unique views, all of which I respect, even when I cannot agree.

I want to share with you a real life situation – happening in real time  - affecting my family.  I want to preface this post with the information that I am a Director of Patient Care Services for a home care agency and have been for 15+ years, so I am well versed on the medical industry, insurance policies, government rules and regulations, both state and federal. I just want to be clear that I KNOW HOW THIS WORKS AS I DEAL WITH IT ON A DAILY BASIS.

Yesterday I received a statement from my PCP for a visit made on 1/5/17.  It showed I was responsible for the entire visit.  I immediately got online to check the insurance EOB (explanation of benefits) and saw that there was a footnote that the visit was not billed as illness or injury and not covered.  This morning I called the PCP billing office and said the bill may need to be resubmitted (codes often change year to year and clearly it was sent incorrectly).  Nope – they were advised it was subject to my deductible.  Wait, what?  No – this was an office visit with my PCP – what codes did you use?

I called BCBS.  Placed on hold.  I explained the conflicting information from the notes on the EOB and the information from the MD office.  Placed on hold.    “Ma’m…. There was a change from your policy last year.   MD office visits are now subject to the deductible.”

Blink, blink… heart race.  “Did I resolve your issue?”  No – you answered my question, but you did not resolve my issue.

I contact my husband’s HR department.  Is this true?  Yes.

I have read and re-read the 20+ pages (front and back) that were sent regarding benefit enrollment for 2017.   NO WHERE does it say that this MAJOR change in the policy will be taking place.  NO WHERE in the information did it inform the blue color workers for this nationwide company, who are likely working paycheck to paycheck, that they were now going to have to pay a combined $9500 (both payroll deductions and policy deductibles) before insurance will pay one dime towards a families care.

I am angry.   I am angry with the company for not disclosing this information. 

BUT - I understand that these changes where made based on ever growing costs to provide medical insurance benefits for employees. I blame my husband’s company for not owning this change.  I blame my husband’s company for not disclosing this information to employees and their families so they could be prepared.  So they could properly plan and know their responsibility long before the need for the care and not weeks (and sometimes months) afterwards once a visit has been made, billed, denied, and dropped on their lap – “SURPRISE!  This was covered last year, but not this year.”

I am angry with my husband’s company, but I am FURIOUS with the system.  I am furious with the corrupt broken system that is in place to assist EVERYONE’S need to treat and maintain life.  I am FURIOUS that people believe that the problem all stems with “OBAMACARE”.  I am beside myself that people think their troubles are ALL because the government came in and ruined it for everyone. 

Yes – policies that were being offered under the rules of the Affordable Care Act became more expensive.  Guess what – so did ours. The policy that is offered by my husband’s nationwide company – the one he has worked at for 13+ years - increased over 40% from last year.  That was shocking to us in October when we enrolled in the 2017 benefits.  The sting of the new terms of this policy subjecting much more to the deductible just adds insult to injury.

Please understand – the government did not raise these costs.  THE INSURANCE COMPANIES DID.  In order to maintain profits, the insurance company increased the cost of these policies. 

The government said – hey – it’s not okay to deny someone because they are sick.  It’s not okay to turn people away because they are going to be too expensive. 

The government said – hey – it’s not okay to not have insurance.  Our system is terrible and it costs way too much money when you are sick, so you have to be prepared.  You can’t wait and hope for the best.

The problem is that the medical industry is imploding on itself because somewhere, somehow, it became okay to profit from the most basic element of humanity – life. 

It is ugly out there right now.  Really, really ugly.  It is very easy to throw blame at each other and draw lines in sand.    
I am realistic enough to know, there is no one answer to the problem.  
I understand that we cannot throw the entire system away and start fresh, as it is just not possible.  
I am hoping for perspective.  
I am hoping for understanding that REAL change is needed in the RIGHT places.

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