Les Jones

I was hospitalized 4 times last year and had 3 surgeries. My insurance covered most of the expenses except for the expected deductables. The main problem I saw as far as one's credit is concerned is that neither the hospital or insurance folks seemed interested in cooperating with one another. One day I would receive a statement from the insurance company showing a bill had been paid - two days later I'd get a letter from the care provider showing that if the very same bill wasn't paid immediately that I would be turned over to collection.

"What do you mean I'll be turned over to collection. Do the records not show that you've been paid in full; which in fact you have?" I thought.

This left me completely bewildered. I'd figure that after so many years, care providers and insurance companies would pretty much have their payment systems down to a science. Instead; even if you've got good insurance which covers almost everything (like mine currently) you can't be 100% assured that the hospital has credited payment that was actually received. In which case out of the blue you can receive threatniing notices for things that in fact have already been paid for. You can always pay for it personally of course - then you have the quagmire of trying to retrieve your expense from an entrenchant insurance company.

One of my old high school buddies was diagnosed with cancer about 3 years ago. He went through all the necessary treatment of chemo and surgery with support from family and an enlightened employer who provided him paid contingency medical leave while he fought for his life.

But he experienced similar payment difficulties as mine. Only his were giant dollar amounts over a period of 3 years instead of a couple months. After numerous mis-reported late payments or payments that were not credited at all; he found that even though he had the best insurance and company support imaginable, his credit was still in the crapper because the hospital and insurance company just don't have their marbles in one sack. They simply don't cooperate with one another on the payment process.

I think there are several reasons this happens. One is that like a bank, the insurance company is motivated to hang onto even legitimate payments as long as possible because it helps their cash flow. They have zero consequences for late payments because their policies state that the patient is ultimately responsible for timely payment of bills. If you take the initiative to pay in advance, it opens an opportunity for the insurance company to renig because they know an individual can't afford to fight them for money the way a hospital can. The hospital on the other hand has to fight to get their money either way. The insurance company is in no hurry to pay. So the hospital or care provider will take any measure to bring pressure for payment including threats to credit or turning people to collection for bills in amazingly short time periods.

Having said all this - I don't think the solution is more government intervention, but rather the introduction of more competition. The halfway house of government regulation and lack of true competition in American medicine creates an environment where really nobody, not the care providers, insurance companies or patients are being well served. I've read proposals for things like decreased regulation, and health savings accounts - perhaps even involving mutual interest between health savings stakeholders analagous to the difference between a credit union and a bank.

Another HUGE help would probably be if care providers and insurance agencies weren't saddled with giant frivilous lawsuits. I can sympathize with somebody wanting a million bucks for having a pair of foreceps left in their chest. It's hard to justify that same amount for a small thing like an accidental scar on your shoulder from getting a wart removed. Sure you're probably entitled to some compensation, but not the ridiculous levels often seen for small oversights or accidents.

It's a F*cked up situation. But I don't think it's because of things being privatized. Rather it's from the lack of a level of privatization that would correlate to real competition.

Meanwhile, be sure and take the doctor's advice to relax and take it easy. If you haven't got your health, you haven't got anything. On the other hand you can apparently preserve your health and lose everything - ROFL.