Health care and mail-in rebates

“What in the heck is wrong with this thing?”

The Blue Cross Blue Shield of Illinois customer service rep sighed into the phone as she tried to locate my profile in the health insurance database.

I couldn’t think of a better way to sum up the state of insurance in the U.S. than her words.

Sixty-two days have passed since five holes were drilled in my jaw for implants. After the procedure, the surgeon’s office mailed a claim to my insurance carrier. Normally, the carrier would evaluate the claim and then respond, within 60 days at most.

But in my case that limit has come and gone, and the amiable secretaries in the doctor’s office say they have not been able to get someone from BCBSIL on the phone to get an update on the claim. So they called me this morning and enlisted my help. I called the BCBSIL customer service line and entered the automated claim locator. The robotic voice asked me for the date of service.

“November 19,” I said.

“We’re sorry, no claim could be found for that date,” the robot replied.

I checked my phone calendar again to make sure the date was right. It was. Maybe it’s just a glitch, I thought. So I tapped a few keys to get to a real live person.

I gave her my name, ID number and date of birth, all of which I’d already entered into the automated system.

A moment or two passed, and she talked softly to herself in that some people do to fill the silence while they’re doing something.

“Did you have a different group number last year?” she asked.

“I don’t think so,” I said. But then I began to wonder whether I’d gotten an envelope and maybe it was buried in the junk drawer or tucked out of sight by the fridge.

“You did have a different group number,” she corrected.

But there was no claim listed for November 19.

“Was it October 21?”

I scrolled in the calendar to see what happened that day. It was my final visit to the hand specialist. “No, that was something else.”

“Did your doctor send it in electronically?” the rep asked.

How was I supposed to know? Wouldn’t this be better, I thought, if the insurance rep actually talked to my doctor’s staff and not me?

“Not sure. I doubt they would send it in electronically,” I said, knowing my doctor’s old-school proclivities.

“If they mailed it in, it might have gotten lost,” the rep said.

Now I was the one who wanted to mutter, “What in the heck is wrong with this thing?”

After a quick call to my doctor’s office, I confirmed that the claim had indeed been mailed in. What happened to it, no one knows. But they’ll send another. The clock begins again.

One of the most mind-boggling parts of these dealings with BCBSIL is that there’s a very good chance it’s all for nothing. Those secretaries at my doctor’s office have told me it’s likely that BCBSIL probably will refuse to cover the implants, and if that happens they would try to get coverage through my dental insurance. And they deal with these kinds of things all the time, so I have no reason to doubt them.

With each visit to a doctor, it seems, I get a clearer picture of how upside down the health care industry is from a financial perspective. Health insurance should be a clear guarantee of coverage from the moment a patient knows he or she needs a certain type of care. But that’s not what exists in the United States. Instead, in countless cases (like mine), the work is performed first, with the patients paying the whole cost from their own pockets, and then the burden is shifted to them to prove that they deserve the coverage (and thus reimbursement).

In fact, the whole situation reminds me of something I enjoyed a lot when I was a kid: mail-in rebates. I know they’re still around, because I just got one in the mailbox last week. (Kacey, of course, thought it was quaint.)

The premise behind a mail-in rebate would be that you’d buy a product , and if you were willing to go through the trouble of filling out a form, addressing an envelope, maybe cutting out a UPC code and waiting a long stretch, you’d get a big discount on the item — or maybe even get it free.

As the pace of society has sped up, you don’t see many mail-in rebates advertised on store shelves anymore. Who has the time? Everyone expects their discounts now, and not to have to do any extra work for it. Most rebates that I see, like the ones at Costco, are applied when the product is purchased. (Which brings up the question of whether “rebate” in that case is just a euphemism for “coupon,” but that’s a whole other issue.)

As I’ve learned through my dealings with BCBSIL, the concept behind the mail-in rebate is still around in insurance. But the process for getting the rebate is so time-consuming and inefficient that no one would bother — except that the product in this case is something that we all have to have: our health and well-being. If getting a rebate required dealing with customer service reps during the course of numerous phone calls over two-plus months, no one would bother.

But in this case, I have to. It’s my health. And as we all know, in the United States, health is expensive.

I don’t want this post to turn into a thesis, so I won’t get into my thoughts on why health care is so costly in this country and how much blame insurance companies deserve. It’s not my area of expertise, at least yet. But there are experts out there, and one of them, journalist Steven Brill, shared his thoughts in an enlightening interview on NPR.

Brill was diagnosed with a bubble on his heart that could burst at any time and kill him. This condition was somewhat ironic considering that before the diagnosis, Brill wrote an article on inflated health care costs that won a National Magazine Award and led to a 512-page book that was released this month.

As Brill says in the NPR interview:

“The first way to look at it, which is certainly the way I was looking at it the morning after my surgery and … eight days later when I walked out of that place a healthy person, is that those people saved my life. So in that sense, would I beg, borrow and steal or insist that my insurance company beg, borrow and steal to pay for all that? Yes. Were the people there highly professional, highly skilled? Did they care a lot about me? Yes. So in that sense, it’s reasonable. …

“In the sense that if you step back the way I did as a reporter and look at the economics of health care in the United States, it’s absurd. That nonprofit hospital makes a lot of profit. The executives are highly compensated. The people who sell all of the equipment that is in operating room have humongous profit margins. The [prescription] drugs that I was given … have humongous profit margins and we have done nothing in this country, unlike every other country in the free world, to control that because we have lived with the illusion that health care can be a free market.”


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