Buyer Beware: How
HeathPartners Subverts ObamaCare To Further Enrich Themselves by Steve
Clemens, December 27, 2013
I’m sure all of us have found examples of the evilness of
supposedly “non-profit” health insurance companies as they seek to maximize
their bottom lines. This complaint is only for $73.24 so it doesn’t qualify for
major outrage but does go to illustrate the lengths to which insurance
companies go to justify the obscene salaries they pay their corporate officers
and then use their “profits” to buy up smaller health providers in their march
to secure more.
At age 63, I’ve been plagued by decreasing hearing loss and
have gone to an Audiology Clinic run by HealthPartners. I like the audiologist
and he takes time to explain my hearing loss and his recommendation to get
hearing aids to both enhance my hearing ability as well as hopefully slow down
or avoid further deterioration. As a conscientious consumer, I price out
similar styles of hearing aids at nearby Costco with the HealthPartners’ model
and with the price being competitive, decide to buy the HeathPartners’ ones for
$2,600 because of the ability of Dr. Geddes, the Audiologist, to take the time
to carefully explain my choices. I’ve had the hearing aids for almost a year
and a half and they seem to work well. Dr. Geddes asks me to return annually to
re-check my hearing and make sure the hearing aids are working properly.
Meanwhile, my health insurance carrier changes due to my
wife’s employer and then retirement and I’m now at the “mercy” [sic] of Blue
Cross/Blue Shield who must now share the blame with HealthPartners for my
unfolding complaint. Under the Affordable (Health) Care Act, aka ObamaCare, all
insurance carriers must provide “preventive care” at no additional co-pay for
their customers. Because my new policy has a higher deductible, I want to be
sure my return for the annual check-up is covered before I go. So I call both
Blue Cross, the insurer, and HealthPartners, the provider, prior to my
appointment last July to be sure I won’t have to pay out-of-pocket for this
check-up since its purpose is similar to an annual physical. Both parties tell
me it “should be covered” – however with the proviso that it will depend on how
the visit is “coded”. I make the appointment, stressing that I merely want only
this as an annual check-up. The visit goes well, the doctor is his usual
helpful self but tells me the “coding” for the visit is done by another
department.
It take about a month or so to get the “Explanation of
Benefits” statement from Blue Cross (maybe I should add “the ones who put the
‘BS’ into Blue Shield” – but their system is no more or less transparent than
the other insurance vultures out there) and notice at the bottom the “amount
you owe” is $73.24 after the insurance payment of $63.72. Since it says “THIS
IS NOT A BILL” at the top, I hope that I won’t see a bill from the provider. But,
alas, the envelope bearing the HealthPartners’ logo with the clear window
allowing the customer’s name and address arrives the next month telling me to
“Pay This Amount”: $73.24. However, the figures they list to get to this magic
total owed by me is different than my “Explanation of Benefits” from BC/BS. The
former claims the charges to be $96 with an insurance payments/adjustment of
$22.76 while the latter tells me the charges are really $179 but the “allowed
amount” is only $136.96 so $42.04 becomes the “Provider Responsibility Amount)
meaning Blue Cross thinks HealthPartners is over-charging for this “service”.
BC/BS tells me it is paying $63.72 but still leaves me with the same $73.24
owed to the provider as my “Deductible Amount”.
So I call HealthPartners to dispute the bill. The “billings”
employee I talk to on the phone is quite friendly and hears my complaint. After
explaining that I called both BC/BS and HealthPartners before making the
appointment, and also telling the doctor that I wished to be seen only for my
annual check-up, she told me they will order a “code review” and will contact
my insurer so I should not pay the bill until it was reviewed. Finally I
received a letter informing me that “HealthPartners Clinics are committed to providing
quality customer service and an exceptional patient experience. The coding for
your services … has been reviewed and confirmed to be accurate.” It went on to
say I could fill out an appeal form if I wished to dispute this decision. The
letter was not signed but “HealthPartners Patient Accounting Representative”
was helpfully typed after the “Sincerely,”. I filled out the form, hoping for
some sanity in this morass.
The letter from Flannery Daley, Operations Manager of
HealthPartners Patient Accounting came last week. I must quote the explanation:
“This service was covered by your insurance and was applied towards your
deductible. Generally speaking, if there is a problem-related diagnosis, a
service is not considered preventive. Because you have a diagnosis of hearing
loss, the annual check is not considered preventive. Therefore, the $73.24 that
Blue Cross Blue Shield has applied towards your deductible for this service
will not be waived.”
It would have been helpful if HealthPartners or the doctor
would have told me this when I made the appointment! Following this logic, I
must pay for my annual eye exam since I wear glasses. I should pay for my
annual physical because I am “overweight” – all this despite the clear wording
of ObamaCare that all insurance companies must provide this preventive care at
no additional cost. I can’t say for sure that a Single-Payer plan will cure all
these problems but I do know that getting insurance companies out of the mix
would greatly enhance the “exceptional patient experience” HealthPartners
promised me.
My friends from Iraq just scratch their heads trying to
figure out the total confusion and obfuscation of the “Health Care” [sic]
system our politics has saddled us with. My new insurance provider starting
January 1 doesn’t have HealthPartners Audiology in their “network”. Now, I’ll
need to call again before my annual “check-up” this fall.
In all fairness to HealthPartners, this rip-off pales in
comparison to my son’s itemized bill from Allina Health for his emergency room
visit this fall to Abbott Northwestern Hospital: 4 chewable aspirins (81 mg) listed
at $26.40 – a bargain since only 2 acetaminophen tablets were $26.20. But
further down a 325 mg aspirin tablet was $26.05. Of course the really important
figures are the lines which read “insurance payment: $11,118.86” followed by an
“adjustment” listed as “insurance discount: $13,360.19” I guess even
HealthPartners (his insurance company this time, not the provider) isn’t
willing to pay those prices.
My pharmacist, Tom Sengupta at Schneider Drug in Minneapolis tells me (about health insurance companies): "They're all evil - but some are worse than others. Try to find the least evil one."
-->The sign in his front window urges us
all to support “Single-payer healthcare for all”. 
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