Health insurance bureaucracy woes.

After several recent medical stuff (cataract surgery, the various followups, then the visit to the emergency room and the follow-up) the clinic's billing department phoned to tell me the insurance company declined the claims because I was, according to them, enrolled in Medicare. Which I am not.

Several months before I turned 65 I filed to enroll, but when I realized that because of my income, and my unconventional employment history (farm work, and the farmer didn't think he needed to pay into social security, so I don't have enough quarters on the books) it would cost me more to get Medicare than to stick with my private insurance company, I canceled the Medicare enrollment before I turned 65. So I've never been covered.

So I phoned the insurance company to tell them that I'm not on Medicare, and they acknowledged that by a phone call to Medicare, and assured me that in 45 days they'd have it all cleared up. Apparently they do everything on paper, thus the 45 days to clear up the matter of my insurance.

Today they phoned me back to say that now Medicare tells them I am in Medicare, and I'd have to call Medicare to clear it up.

I phoned Medicare, and got a recording saying that for enrollment issues, I had to call Social Security. I called them, and their recording said that the current average wait time is 45 minutes!!! I guess with the ACA going into effect, they are flooded with calls. I've never actually been billed by Medicare (since I'm not enrolled) and they've never paid any of my bills (even though the clinic tried to bill them after the insurance company refused).

So now I'm going to have to pay a visit to the Social Security office and try to straighten it out. Of course, the only way to get an appointment is through their national phone number with its 45-minute wait time, so I'm going to have to go there and hope they don't have a line of people all the way around the block.

 

In other industrialized countries, where medical care is as good as in the U.S., the cost is about one-third. While I was living in Spain I had a treadmill stress test on one occasion, due to the heart arrhythmia that eventually led to my heart operation back home. And on another occasion I went to the emergency room for what turned out to be a urinary tract infection. In both cases, where I had no insurance coverage and I paid the full bill out of pocket at a private hospital, the cost to me was about one-third what I've had to pay here for the same things after my insurance has paid its share.

We spend twice as much for insurance companies to decide which claims to deny, as we spend on actual medical care. Although I suppose malpractice insurance accounts for a chunk of that as well.

As for the Social Security office, I am always polite and civil. I still have a copy of the Air Force report of my arrest for nonviolent civil disobedience that eventually led to my serving six months in federal prison. The report of the Air Force guards who arrested me states that I was polite and courteous throughout. Getting angry at cops, judges, prison guards, customer service reps, government bureaucrats, etc., never does any good.

Sometimes, in the privacy of my own home, I rant and rave. On the internet I'm blunt about my opinions. But when dealing with the above sorts of people, I am calm, polite, and courteous. Always. My real concern is that there may be such a long line that I can't even get in to talk to anyone, and meanwhile the insurance company is refusing to honor any claims, even though I've been paying my premiums every month.

 

^ Well that certainly seems completely irrelevant.

As for Medicare, I could get Medicare, no problem. But it would cost me more than my present private health insurance. All I have to do now is straighten out the insurance company on the fact that I don't have Medicare. (I went onto the Medicare web site, entered my information under "Find your plan" and it said "No records found." Which is to be expected since I don't have Medicare, and I don't want Medicare. I just want the clowns at Medicare to quit telling my insurance company that I do. -- Assuming that the insurance company rep was even telling the truth when she told me that's what they were told.)

 

So I phoned Social Security again this morning and again they told me there was an hour's wait, but this time (unlike last time) the machine offered me the choice of getting a call back. You have to give exactly the right responses to a series of questions before you get the opportunity to ask for a call back!

So an hour later they called me back. They confirmed that I am not on Medicare, so I asked for a document I could show my insurance company. Unfortunately, they don't have a form for this or a standard procedure, so I waited on hold for about a half an hour while the guy talked to his superior, and the upshot is that he wrote a letter that they will send me.

Armed with that information I called my insurance company again, and after another quarter of an hour while this guy talked to his superior it turned out that the phone call I got yesterday, telling me that they had confirmed that I am on medicare, never should have been made, that in fact the paperwork to remove the Medicare tag from my file is in progress and will take a week or two to process.

So this whole thing has been a colossal f-up on the part of my insurance company, beginning with (most likely) their assumption that I would be on Medicare because of my age, and maybe someone from Medicare telling them that anyone over 65 is eligible for Medicare.

Presumably this will all get straightened out, and if not, I will have the letter from Social Security that I'll be able to wave at the insurance company. My health insurance company is really crappy, but all the other alternatives are worse.

Grump, grump, rant, rant, curse, swear, kvetch and gripe!

At least I didn't have to drive down to the Social Security office.

 

BTW, the Social Security Administration is still using computers running DOS!