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Words From Wiser: Health Insurance and Billing Complications

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From Chuck Wiser, 7/22/21

When first asked if I would consider offering my “words” to the public on a regular basis in the Wellsville Sun, my first reaction was just as it was when I started teaching at Alfred State College. Feelings of fear and uncertainty as to what I had to offer filled my head. My second reaction was that of profound gratitude for a “prayer answered, and a lifelong ambition come to fruition even at this late stage of my life. I immediately started a list of topics of which I had feelings or opinions that might be worthy of sharing. So far events have transpired that led me to discussions other than those on my list. Fortunately, a recent Doctors office visit overlapped with a topic on my list, as the same questions and concerns that put that the topic in my head, came front and center.

Better Rates, Lower Fees

Today’s topic is going to be a personal view of Health Insurance, Medical practices, Insurance coverage, and how they impact all of us. I am not an expert, or even really that knowledgeable on the ins and outs of regulations and practices, but I know how some have affected me.

Given our years of history my wife and I always wondered how or why her Mother paid her medical bills without ever a question or hesitation. If she got a bill, she paid it, right then. Our personal experience has been that it’s not always prudent to do that. Admittedly things are a lot different these days but some of what we perceive as weaknesses (to us) have always been prevalent. Hospitals routinely send out bills prior to having received payments, or even in some cases, not even having billed the insurance carrier or now, Medicare. When questioning the institutions practices, we have been told that they would refund us if we overpaid. We all make mistakes, and they are understandable, but the frequency of them is startling. All too often we will get a notice from the insurance carrier that a billing is for something not covered under our policy. When looking into it the problem is usually that of an incorrect procedure code having been used.

Several years ago, I had reason to visit a local hospital (not JMH) Emergency Room to have a dislocated knee, with replacement, put back into place. Ironically, having been through the process twice previously due to a flawed knee implant, I had to walk the attending ER Doctor thru putting it back into place. I received a bill for almost $4000 billed as a “surgical procedure”, from a doctor that was not a participating provider on my insurance plan and had received a denial letter from the insurance company at about the same time. I wrote the doctor and the insurance company letters clarifying the above and the bill went away, fortunately.

Health Care plans has been a “hot topic” for several years now and despite our differing views on that, there are things being done that drive the costs for all, or most of us, up. I have been dealing with torn rotator cuff issues for several years now, with more in my near future. The office visit that triggered my thoughts and steered me toward this topic, involved what I KNEW, to be a rotator cuff problem. The rotator cuff is comprised of tendons that attach to the shoulder. When they are torn, despite what caused it short of falling, or being in an impacting accident, the bones are not the problem. The first thing they did, and this always happens, was take an Xray.

The explanation was that they need to rule out a fracture BEFORE they can do anything else. In the past, when questioning the reasoning or need of an Xray, it was explained to me that it is an Insurance Company requirement. It adds to the cost, and payment by the insurance company to the medical profession, and somewhere back along the line is added into my insurance cost.

Another incidence of insurance coverage practices that I have experienced was while going through rehab following a previous knee implant. My knee needed rehabilitation, but half of my Physical Therapy exercises included reaching, turning, lifting and pulling with my arms. When later questioning the “why” of this it was explained (by a highly placed individual in a different institution, that it was due to “Billable Hours” in the insurance claim.

And yet another. Having been involved with having transported a family member to a local hospital emergency room a few times over they years, the waiting process, and seemingly idle time in between actual interface with the health care professionals, borders on the ridiculous. Let me be clear here. I am not criticizing the institution, nor the wonderful, expert, caring and considerate hospital staff, but rather, the practice of building hours. This again is an anecdotal and not necessarily “official” statement or criteria, but I have been told that, in order to bill and receive a certain amount, for certain claims, you have to have been in their keeping for a fixed length  of time. I am not suggesting or inviting a rapid discharge or not taking the time for thoroughness, but a six hour stay in the ER for what turns out to be minor problem, is questionable.

Let me end this by stating how truly blessed we are to have these institutions of health care and emergency services available to us, and we owe all of the caring and professional staff our thanks and gratitude. Life would not be as we have it, without you. Doctors and Nurses rock!

I penned these words while a patient in a local hospital a few years ago:

They Now Are Like Rainbows

They used to be all dressed in white, while making rounds were quite a sight.

All prim and proper day or night, some say they’re angels from the light.

If work demanded the extra mile, if you were lonely, they might sit awhile.

If time permits that is their style, they go about their tasks, all smiles.

Angels of mercy as from above. Who knows just what they are made of?

They do their job come push or shove. They care for us with tender Love.

The times have changed they dress so bright, looks of a rainbow, all colors of light.

They bring the sunshine through dark of night, while making rounds still quite a sight.


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