Friday, January 29, 2010

The Healthcare Mafia

One of my new year's resolutions is to deal with out-of-control instituationalized wankerism from faceless robots who want my money, but also a large amount of my time and energy to deal with their incompetence. God bless people who are happy with their insurance plans, like Captain Bob, Tim's stepdad, with whom I am impressed as I get to know him better. We spent a weekend there last weekend and it was actually pretty fun. I think we wore him out a bit, but he was really cool. Captain Bob is a retired Navy Captain. He commanded a diesel submarine. If that's not interesting, I don't know what is. I am curious about it and I questioned him about life inside what he describes as a "long sewer pipe" beneath the surface of the sea, manned by personnel listening through headphones and interpreting sound to navigate through the water, like bats in the night. Anything audio is interesting to me and next time I see him, I will have to ask him what all of that sounds like.

So Bob is happy with his insurance, USAA. No problems there. Can I get USAA? No, I don't think so...I'm not military. Would they take me? What if I begged? "Please, I'm a good girl who pays her bills, and even pays them on time. It's just that with all these companies and subcompanies and contracted amounts that I don't know about, it would just be nice to have no hassle. I can pay for it..really...I already do. Just be reasonable. Please..is it too much to ask?"

I mean, I'm actually pretty healthy. Mental health treatment is the one thing I've had all these years and I am grateful for that investment, because if you have good healers working with you, it helps. If you get shitty ones, which is entirely possible in psychiatry or any profession, they will fuck you up worse. So you learn to weed those out.

I had a psychiatrist who ultimately weirded me out. She had prescribed Lexapro (this was a few years ago) and it did something to me that I've never experienced before. After a week and a half, I guess when it started to kick in, I freaked out so badly that I literally could not move from my bed for three days. I started cutting myself----something I have never done, ever. It was the only thing that brought relief from the voices in my head, and yes, there were those too. Another new and interesting experience. Not an audio phenomenon, but the voices were real regardless. The negative emotional energy they generated was tremendous. She told me to keep taking this medication.

I thought that was an insane idea. I told her I absolutely could not do that. I stopped taking it. After three or four days, I was OK. But those three or four days were hell. And with an office right down the road, she did not call to check on me, did not say "come down and see me" or anything remotely compassionate. She was weirded out and mistrustful because I insisted on taking the powdered leaf material that has been an additional antidepressant for me, because the others don't always work. It's been a constant amount, works well if short-acting, and until an antidepressant med started working for me, I was not willing to stop taking it. She behaved as if whatever else I was taking, presumably the leaf material, was causing the problem. I knew this not to be true, because never before or since did I have this kind of head trip on the leaf stuff. But insisting I continue on the Lexapro seemed nuts to me. She wasn't having to live in my head, and could not witness or understand how hellish it had become in there.

I told her I had done some online research and had seen that some antidepressants have a dramatic negative effect. I said it seemed to be well known that there are bad reactions to them, and that in general the medication is best stopped, from what I had read.

She told me that she was the doctor and I was the patient, and to go to the emergency room if I needed to go anywhere or see anyone.

That was the last time I was her patient. I stopped seeing her and never explained. I could not believe how frightening the whole experience was.

My psychiatrist now rocks. I'll write about her soon. I have a great therapist too. So the insurance is worth it, but I have had some frustrating times this week dealing with the insurance mafia. So I wrote the following.

It segues in to non-insurance stuff. I just thought you might find it interesting.
It was a summary of a customer service call to my health plan through AFTRA.
Who I like, but the insurance isn't all that great in paying for medication. Nevertheless, they are very helpful and cool people.

OK let's see if I can get this right.
AFTRA H R
01.29.10
3pm end of call


Michelle at Aftra HR was very cool....tells me that Blue Cross is denying the claims that UCLA Pathology is sending them. Said it has nothing to do with me. AFTRA has Blue Cross in California, and will pay up to 400 dollars for a "regular visit."

ask

need to clarify whether a "regular visit" means the well woman exam or includes other office visits. I had a visit for my thyroid and it seemed pretty regular to me, but whether this would be what they call "regular" I do not know.

She says AFTRA paid out 110 dollars for 2009 (out of the possible 400)and I am not certain of this

(**ask**)

237 or some odd dollars for 2008.

She said UCLA could have collected more money from AFTRA, but instead billed Blue Cross (for exhorbitant amounts like 400, 500 dollars a pop, a number of bills listing different services with ambiguous titles like "outpatient." Different amounts, presented on a grid with various seemingly-unrelated numbers, which come separate from other bills demanding different amounts for the same date of service..you see where it starts to hurt my head.)

There is another claim I described to her, which went straight to collections because I refused to pay the outrageous 500, 600-dollar amounts the bills were telling me I owed, for various tests and results and analyses. None of this is stuff they ever used to bill me for. I've been using UCLA for years and have really started to feel betrayed by them, which is a shame because of the excellent treatment I have received for depression, from many competent mental health professionals who contract with them. I am on the verge of begging my primary doctor, who I absolutely respect and admire and like---to see me outside of UCLA. Is that ethical? Would it be insulting? Would she get in trouble? I'm afraid she could, which is why I probably wouldn't ask, without doing a lot more homework and research. But my impression is that people can and do retain doctors on a fee-for-service, person-to-person level. And maybe that's the way it should be. It would put the costs squarely where the market would price them, and not force us to wander for hours through recorded robots, menus, touch-tone hell and no-man's-land-hold with the shittiest music ever, and even advertisements that drill into your ears like rape ---(OK! It's enough that I'm giving you my business! Don't fucking sell me through a commercial, sell me with YOUR SERVICE......BUT THEY KEEP ON COMING...OVER AND OVER and over. )

I didn't mean to yell when I started this document.


She says I need to call Blue Cross and tell them to call AFTRA if they need help working it out. She says they denied a whole bunch of claims,(probably because the claims were bogus - that's what I'm wondering). Or possibly not. The claims certainly seemed extraordinary, like way beyond what might have been contracted between the parties, but I don't have much knowledge of those contracts. It's the sort of information you might not even be able to get, unless you have a customer service person cool enough to tell you, like Michelle at AFTRA.

She said I can call back Monday, she'll put me on hold, and call Blue Cross for me, if I want. I'm sort of curious as to what Blue Cross will say, so I might call them and then call her and have them talk if there's still disagreement. Of course, the customer service person could say there's agreement but there really not be. I tend to trust Michelle, but Blue Cross? Who knows what the hell's up over there? Until I see something in writing, nothing convinces me that these mail bombs won't keep flying out of my mailbox attacking my head.

When I was little and I learned of insurance and insurance companies, I literally could not believe it. Because doctor visits weren't ruled by insurance before. It made sense to me, you go in, you pay. You pay for medicine. It's generally something you can afford, at least my parents could. But then I remember the concept of insurance being described to me, and I was flabbergasted. Didn't get how it *could* work as a business model without major problems. And still can't.

I get the concept of insurance. But it also seemed so clear to me that it was an extremely bad way to do business---depersonalized it, when medicine is such a personal issue, between people in a community. Insurance has destroyed that community of people who work individually with doctors. Everything is disconnected, impersonal.

A hell of a way to do medicine, and it scares me should I ever get sick.

At the same time, what the insurance company actually does is cost the patient rather than save the patient. They say they're saving us from the horribly huge inflated costs that are now charged for medical care, costs far beyond the pocketbook of normal civilians who work an honest gig for slave wages. So here come the Insurance companies to save us. Ten dollars for a doctor visit? Awesome!

Never mind two hundred dollars goes into their pockets from you, every month, for me it got up to 400.00 on COBRA. 400.00 a month for three years while I healthily required no care at all (well-yearly exams, and mental health issues, which is the whole reason I had the medical insurance. But all of that went pretty smoothly, I must say.) Was it worth the money I paid? Didn't have a choice, frankly. Whatever the cost, if you've got mental health issues, you must get treatment. If you have clinical depression, you must get treatment, if you want to be in the world in a good way without being a total downer to be around. That sort of matters to me. So I paid for it. No regrets. But, Damn. That's 12 thousand, four hundred dollars. I was taking home around 26 thousand, four hundred a year each year. After taxes.

To a company that did nothing but push paper around, act impatient with me on the phone, and now are denying the claims and not letting me know why, or communicating with my insurance company, who could arrange to pay them what they're owed---this is all I get for those hard-earned dollars I allowed them to siphon off for all that time? Money I could have otherwise used? With all that customer service, why can't they have their customer service people do their jobs? What are they all doing over there? For all the dough they're paid, they're lousy bookkeepers, obviously, and something's got to give. They want way too much to generate all that paper and not communicate with each other or me beyond computer-generated bots and paper love bombs announcing their gouge amounts. It's total bullshit.

Their computers are out of control and just spamming out bills one after another, and ignoring the numerous letters I have been sending in response. Actually, they did not completely ignore them. They told the collection agency they had "adjusted" their claims downward. They didn't tell me that. I finally called the collection agency and paid off the reasonably-revised-downward claims. And lo and behold, what has been coming to my mailbox this month, but a bill for the very date of service I paid the collection agency. And it's reduced from the amount I paid the collector---80.00; this new bill says 47. Well, hey, that's great. Then they owe me money now. Supposing they got the payment I made to the collection agency. Fortunately, I have a tape recording of the phone call with the collection agency of my paying them.


Why would anyone want to work in such a bullshit industry, anyway? Shut the frigging insurance companies down, man. Because without someone at AFTRA or the occasionally customer service rep who really goes above and beyond to HELP you. Rather than browbeating you about your record keeping while you're getting raped by the bank's recordkeeping shenenigans, not to mention my own money baling the bastards out. You work for ME, I wanted to say. Literally. Me the taxpayer. Why don't you think about that, Ms. Update Your Register Every Time You Debit. The problem wasn't even that. It was the automatic debits that come out every month, and the merchant changes the days up on you so you never truly know when the amount is debited out. But now I'm talking about the bank mafia, which are arguably worse. They're worse because they lecture you when you're just trying to keep up with their methods of debiting and indicating debits in an increasingly-arbitrary and not-necessarily-current fashion for you to monitor. But that's another problem. For which I am about to find a solution. Some nicer mafia. More reasonable people. I'm sure it can be done. There's got to be someone nicer to manage my money. I certainly pay them for the privilege.

But back to the Insurance Mafia. For four hundred dollars a month (which is what I paid Black Nightmare of Death Cross during the COBRA years) you'd think you'd at least get a little loyalty. At the same time, what has been coming out of the UCLA Billing system and into my mailbox is so outrageous as to be like an attack of paper butterflies which have teeth and tear chunks out of my mind.

For a while I got so I didn't open my mail. My new year's resolution is to deal with my mail. And my bills. In a more immediate way. I pay my bills on time, but it's bills like the ones from the Medical Mafia that demoralize the crap out of me, because they come, and come, and come. I have a whole file full of letters and notes. Every time they would send me one of their outrageous bills (UCLA, that is) I would fire off a response and include copies of my insurance information. I did try speaking with them on the phone once, and it wasn't a very pleasant experience. A desire not to repeat that experience is the basis for my corresponding by snail mail with the vast warehouse of phone robots sweating under the constant audio surveillance of supervisors weilding obscure regulations and procedure changes. I feel bad for those people. They talk and listen all day. Wouldn't they like to say something of their very own, that's not scripted? Well, some of them do. I had one woman insult the hell out of me and then when I protested, tell me that I was being difficult. I told her I wasn't being difficult, she was being an asshole. And she hung up on me.

"They can do that," Tim said, "if you use profanity, because profanity is abusive."

I'm a pretty nice person. It takes a lot for me to call someone an asshole on the phone. My first instinct is to speak courteously and genuinely to people. My mother brought me up that way. She was direct and forgiving. If anything, she was too nice to people who ran her over until her spirit was literally and physically beaten to death. Yes, I have some issues about my mother. She died when I was nine, and watching her go down left a mark on me that is part of the fabric of who I am. So, how nice to be has always been a central issue for me. I have lessons I've learned about when to stop being nice.

Because sometimes being nice, and getting along to get along, equals not only cowardice, but a loss of control over your situation. I'm not 100 per cent for having total control over things, but when it comes to issues of sustenance and who I spend my days with, that's pretty important stuff. Being suddenly evicted from a place I'd grown comfortably numb (my old radio station) was a real cause for reflection.

And to the people who dis reflection and say "time to get over it and move on", my answer to them is that moving on isn't possible for me until I know what I want to do differently from here on, to avoid problems that came before. That whole thing about the unexamined life not being worth living, that I can get down with. "Move on" sounds suspiciously like "don't bother me with your problems." And that's OK. I didn't bother anyone who didn't ask about it. You ask, you receive. I'm just that kind of gal.

It's not that what came before was so terrible, I actually had a great time working at the place for a long time. But being disappeared and unpersoned by people I had done really good work for was a shock. I am pretty sure it's because I pushed back as much as I did. But I had to. If I'm going to be pushed off the brink, I can at least go down screaming and pointing fingers. ;) And hopefully land somewhere good, which is what happened. So it's all good and it's all worked out----but not without pain. And as for that, I'd rather feel it than not. What doesn't kill you really does make you stronger. I'm no longer afraid to be seen as not nice. It's not that I don't give a shit. It's that people who have agendas against you can get away with kicking over your sand castles, and as well-brought-up child of my elegant, gracious mother---I turned the other cheek and drove my bitterness inward. I should have fought. Why not? You either live in fear, or you fight for what you believe in. And for a peacenik like me, that's exactly what I feel I've done with my life--participated in things I believed in. So that's another reason it hurt leaving K-CRAZY.

Because I genuinely felt that the overall tone of the place had changed radically from what it had been, and what I signed up for when I came to California with a specific plan of working at that radio station. It was doing the kind of radio that I was doing. Different and interesting. Poverty wages but a social exaltment and excitement that is far cooler than cash, and the whole reason public radio is a different experience. One I should write about, I think. But maybe more on that later.