Fight Club

There are many reasons why politicians who see every problem as an opportunity to lump more and more regulation upon the world can get away with it, and one of them is because insurance companies have a knack for screwing people over.

I have a high tolerance for pain. In fact, I annoy my wife because I have a history of pushing myself until I do strange things to muscles and joints that require her to put me back together again. But in July, 2011 I hurt my shoulder pretty badly. Instead of telling my shoulder, “Too bad, we’re exercising today,” it screamed back “You’re not going to get any sleep because of the pain you’re in and then you won’t be able to lift your right arm above your head to wash your hair. For weeks. I hope you’re ambidextrous.” It was obvious: I had to go to a doctor.

After consulting with a specialist, I got an MRI and two bottles of painkillers. The good news was that I just severely sprained my right shoulder, and that the painkillers, rest and eventually rehab would get me back on track. (It took almost a year and a lot of restraint in the weight room, but everything finally healed.) The bad news was that after I thought all my bills were paid they came back again and again and again.

Douglas Ernst wall ball
Here is me in April, 2011 doing my “wall ball” workout. Past Doug has no clue that the next year will not be fun for his right shoulder, or that he will receive a bill in the summer of 2013 for an MRI that took place in the summer of 2011.

During this whole process I was under the impression that my MRI would be covered, but it turns out that while the MRI is covered, the ink they inject into your arm or any number of random things leading up to going into the tube might not be. Why? Your guess is as good as mine.

Here now is the conversation I had with the billing specialist at the center where I had my MRI:

Doug: In September, 2011 I was charged $3600 after I thought everything was taken care of regarding the billing for my MRI. I talked with someone in the office and then in December I received another bill for $900. In my last conversation I was told that everything was taken care of and I was in the clear. Now, it’s June, 2013 and I receive a random bill for $200 — and it says you want it in three weeks. I don’t want to direct any negativity your way because I know it’s not your fault per se, but I hope you can understand why I would be frustrated with this situation.

Billing expert: The way your insurance is — your insurance company keeps telling us to bill MedSolutions. I’ve gone over this with them again and again and again that we did not have a contract with them at the time you had these services rendered. If they called MedSolutions themselves they’d know that. I’ve also sent them a copy of the denial. Your insurance continues to deny the claim and won’t pay it. I don’t know why they’re doing that because they paid three other charges for the same date of service — a shoulder MRI and an arthrogram injection. We don’t expect you to pay in three weeks. Basically, the only reason I sent the bill out to you was to get you involved. Sometimes when they hear from the patient it will move them a little bit more quickly.

Doug: Should I give you my HSA card number and just pay it? It’s my money. I mean, it’s supposed to deal with whatever my insurance doesn’t cover. I just want to get this over with. I’d be annoyed if I couldn’t use my HSA in this situation.

Billing expert: If you want to pay it you can do that, but your insurance really should be paying it. It’s not that it’s a non-covered procedure. It’s just that they want to ping-pong the claim between themselves and MedSolutions. They’re not understanding that MedSolutions has no involvement because we weren’t even contracted with MedSolutions through these types of claims in 2011. Once Med Solutions denied the claim, which I knew would happen, I sent it to your insurance company with a copy of the EOB from MedSolutions denying the claim. I also sent an appeal to them and they’re still not paying the claim.

Doug: I’ll just let you run my HSA card and if you get your money and if they don’t like it then they can just deal with me. Perhaps it will happen in 2015.

Here’s the deal: I did exactly what they wanted. Instead of calling them and getting involved in the ping pong match, I ate the cost with my own money. I did the math in my head, and the time I figured I’d have to spend hounding these people was more costly than just coughing up the cash. The billing specialist — whose job it is to get the insurance companies to do what they’re supposed to do — couldn’t do her job adequately in this case and got the patient involved. But I couldn’t get mad at her because I have a picture of some nice lady wearing scrubs who gets yelled at every day by guys like me. I can’t go nuclear on a lady who has a job that would drive me insane within five years.

However, I do have an image of some emasculated guy in a suit and tie who sits at really big conference tables in opulent buildings somewhere in Washington, D.C. or New York. I can get mad at him, and it took all my strength to filter my anger into something productive with the billing specialist so that she would be happy and I would be happy and we’d just get the whole ordeal behind us. She ended up waiving certain fees and I only had to pay $95, and I’m assuming the way I conducted myself on the phone had something to do with it.

The problem is that not everyone is like me. There is an inner Tyler Durden inside of me, but because I’ve been raised properly and because I have a sense of honor and integrity, he will not get out. The same can not be said for everyone else. If I had to deal with this for what is a routine (nowadays) MRI, what happens to people with all sorts of strange cancers or diseases? I shudder to think.

When you habitually screw over law-abiding citizens who have done nothing except play the game the way the rules have been laid out before them, you will receive blow back. People bought into the Affordable Care Act thinking it would solve many of these problems, but it will only make them worse. It has already done so, and if you don’t believe me I suggest you talk to your primary care physician.

If conservatives can not effectively explain ways to deal with insurance companies while at the same time putting more power into the hands of the doctors and patients, a collective anger will go from a simmer to a boil. It will be too much for the pot to contain. It will spill over in an ugly manner, and the sad thing is that it could all be prevented if the best and brightest among us would find a way to work together.

I told my wife that the first thing I thought when I woke up the morning after receiving another bill was “I am a volcano.” She asked me if my mother was a fish.

William Faulkner references aside, public policy makers need to take this seriously. There are millions of other volcanoes out there, and not all of them work on ways to redirect the flow of lava away from the population.

Listen to this conservative space monkey. He’s telling you that Project Mayhem is just around the corner, and you can stop it if you act now.

Insurance MRI

Insurance

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About the Author Douglas Ernst

I'm a former Army guy who believes success comes through hard work, honesty, optimism, and perseverance. I believe seeing yourself as a victim creates a self-fulfilling prophecy. I believe in God. I'm a USC Trojan with an MA in Political Science from American University.

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