Friday, May 16, 2014

Nick Tortelli's adventures in American Health Insurance

Sometimes I get a sore neck.  Then I walk around like Nick Tortelli for a few days or a week.

It happens maybe three or four times a year, for maybe the last decade. When it happened last winter, the pain actually put me in bed for a day or two until I saw a doctor and got a prescription for a muscle relaxer. Don't get old.

There's a physical therapy place two blocks from my apartment where I've been a few times and it seems to help. After I started going there I didn't have full Nick Tortelli syndrome for months. Of course, it's usually three or four months apart, so that proves nothing. Still, it seems to help, but I haven't been in a while. This is because my insurance company only approved four visits. (Initially the UCSF doctor prescribed a UCSF physical therapist, without asking me what I wanted to do, but that's probably just because they are all trained by default to put their employer's interest above that of the patient.) In order to get more visits paid for, I have to see my doctor again. *sigh*

Meanwhile, I got a bill from UCSF on an unrelated matter that should be 100% covered by insurance (I have GEHA). I looked up the procedure, the hospital, and the name of the doctor on the bill, and it's all 100% covered by GEHA. It took 20 minutes on the phone (I guess I should be grateful that it only took this long, and that the wait was only a minute or two, despite the warning that they are experiencing "unusually high call volume"?) to establish that I was charged the out-of-network rate, because the specified doctor is not listed with GEHA under the tax ID number used to bill. The mere facts that the doctor is listed in GEHA's directory, the hospital is listed in GEHA's directory, and the procedure is listed in GEHA's brochure as 100% covered are phantasms. So it's my responsibility to call UCSF and tell them to (I'm not making this up; I asked what exactly to tell UCSF and wrote it down) submit a W-9 for the "provider" (no doctors or nurses in insurance-land, just providers of services) and then to re-bill GEHA.

And as someone with a full-time job and health insurance, I'm one of the lucky ones.

Come on, Loretta, we're going to go establish single-payer.


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