As I'm sure you often find to be the case, this letter was prompted by an incident. Today, my wife was scheduled to have arthroscopic surgery on her left knee. This has been on the calendar for about a month. We have medical insurance provided by my work (United Health Care HMO) which I contribute significantly towards., and which I know is pretty expensive. Last evening, we received a letter from the ambulatory surgical center where the procedure was to be performed (Salt Creek Surgical Center in Westmont) advising us that essentially EVERYONE involved in the procedure was an independant entity and would be presenting a separate bill. It also stated that there was a possibility that some of those independant entities MIGHT not be covered by our insurance plan. It was up to us to figure out which, if any, of those were, or were not covered even though they had not provided any person's name or address.. And, we would be held liable for ALL costs not covered. We were unable to contact United last evening - before the surgery. This morning when we showed up at the facility they INSISTED that their financial responsibility forms be signed or "there won't be any surgery." I attempted to contact United on a cell phone, and after 15 minutes was able to speak to a person. Not a particulary competent person, who had something of an accent, but finally, a person. Using the information that was provided in the last minute letter from Salt Creek, the person at United was UNABLE to locate the anesthesiolgist's service in the "in group" listings. Likewise the "surgical assistant" group. The facility manager at Salt Creek was unable to quickly provide even so much as a zip code for these groups. Attempting to CALL the anesthesiologist's group got only a voice prompt that would let someone find out how much they owed, and never permitted contact with a living person. Eventually, Salt Creek WAS able to get the head anesthesiologist on the phone, who was sure they had an agreement with United, but couldn't say for certain whether it covered ALL their various plans. By this time, the clock had passed the appointed time for surgery, my wife was upset almost to hysteria, and it appeared that the facility manager was having a little problem keeping her composure as well. Even though the doctor was satisfied that he was "in plan", the surgical center was satisfied that they were "in plan" and the anesthesiologist had confirmed that their services would be "no problem", Salt Creek STILL insisted that someone sign a financial responsibility form. My wife was so upset at this point that she was no longer williing to undergo the procedure. Too much aggravation, too much stress, too much incompetence. We left and she practically fell down in the parking lot weeping with pain and frustration.
The problem I see here, asidie from the incompetence of the person(s) at Salt Creek who sent this damned letter out to arrive at our home late afternoon the day before a sheduled surgery, is that - WE HAVE NO RECOURSE in the event that United Healthcare or someone involved in the surgery presented us with a bill for thousands of dollars -- either through negligence of the biller, or the untimely payment of bills by United Healthcare. They clearly stated that after 60 days, we would be liable for the entire balance if our insurance carrier had not paid. Neither my wife nor I have any direct contractual relationship with United Healthcare, and we are forbidden by law from suing them. The health care providers that DO have a contractual relationship with United Healthcare don't seem to trust them to pay as agreed. Far as I know, they CAN sue them if they don't meet their contractual obligations. Both my boss and I pay through the nose every month for this healthcare, which is supposed to be covered at 100% and not even a co-pay. Why is it so difficult to get the care we have paid for? Why do we have no recourse if the care that we have paid for is not provided? Why are doctors permitted to completely sidestep their responsibilities by laying the blame on "their billing company." Why are so many of these people totally incompetent? Why aren't my elected representatives taking steps to see that us lowly medical services consumers are protected from these types of maneuvers by law? I beg you, please get some health care reform measures passed that protect the PEOPLE instead of protecting the corporations.