Health insurance hell

I’ve ignored my health. Last year, we were busy packing up and moving from Connecticut to Florida, so I skipped my annual physical. Once we got here, I no longer had a doctor to call if I needed one. So last month, nearly two years after my last doctor's visit, I logged onto my insurance company’s referral web site, found a primary care physician who seemed competent (e.g. he went to a top med school) and scheduled a check-up.

Like all doctors in our litigious society, he needs to cover his ass to defend himself in case I sue him for missing a pre-existing condition so he sent me to lots of specialists who, in turn, ordered all sorts of tests.

Over the last few weeks I’ve been poked, prodded, X-rayed, CAT-scanned and have had cameras inserted in places I had no idea cameras could go. Everything has checked out great so far and only two tests remain. If those turn out fine, I should be good for another 50,000 miles.

I'm sure you're wondering who’s paying for all this medical work. The answer is, I sure as hell don't know.

I have to buy my own health insurance. To keep the monthly premiums affordable, I pay out of pocket the first $2,500 in medical expenses I incur in any given year before the insurance company is obligated to pay anything. I was under the impression that once I paid that amount, insurance would take over and pay the rest of my expenses through December 31. But that isn’t the case.

I keep receiving from my insurance company emails inviting me to check the status of my various claims on its web site. When I log on, I've found that the company is paying fully or partially for services and procedures I thought weren’t covered, but is not paying for expenses I thought were covered. The claims status report shows the amount the provider billed, the amount the company says it negotiated to pay the provider (who is apparently content to accept approximately one-tenth as much as he or she billed) and the amount, if any, for which I’m responsible. It’s confusing as all get-out. Then there are the networks. The company pays in full providers who belong to certain networks, pays partial amounts to providers in other networks and pays zippity zip to those who are out-of-network, even though the receptionists at the out-of-network providers claim they accept my brand of insurance.
  

To wit, I’ve paid $2,000 out-of-pocket since July 1. You'd think I'd just have to pay $500 more before the insurance company starts picking up the tab for everything but no. It claims I still have over $2,100 to go until I’ve satisfied my deductible. Very confusing.

Even more bewildering, the claims status report lists charges from providers I’ve never heard of for procedures I’m not even certain I had. Other services I know for sure I received aren’t listed at all.

Here’s my latest statement:

CLAIMS STATUS REPORT

Insured: Dryden, T
Plan: B
Blood Type: Yes

DATE	PROVIDER	SERVICE	AMOUNT	NEGOTIATED	YOU MAY	NETWORK
			BILLED	RATE	OWE
7/11/2014	HUXTABLE C	OFF VISIT	$950.00	$56.99	$75.11	NBC
7/12/2014	HAUSER D	CYTO/SCAN/H	$46,842.00	$10.00	$0.00	ABC
7/13/2014	FEELGOOD DR	ROTATE TIRES	$594.00	$50.00	7/11	NA
7/32/2014	JEKYLL DR	URINE ANAL	$666.66	$66.66	$6,666.66	N/A
8/1/2014	NURSE JACKIE	BLT N ICU	$100.00	$17.76	$0.00	SHO
8/1/2014	WELBY M	SPAY/NEUTER	$15,320.00	$1,000.00	$5,000.00	ABC
8/2/2014	TROY C	401(K)DEP	$5,999.90	$599.99	$0.00	FX
8/4/2014	HOUSE G	HRT TRNSPLNT	$94,333.11	$00.00	$94,333.11	FOX
8/6/2014	KIMBLE R	1099-E	$3,462.45	$100.99	$500.42	ABC
8/6/2014	ZHIVAGO Y	ANASTASIA	$875.68	$1.11	$485.23	HBO
8/8/2014	QUINCY	PATHOLOGY	$58,376.00	$123.45	$2.99	NBC

The only thing I know for sure is this: If the insurance industry is so screwed up it can't even send statements you don't need to be a CPA to decipher, it's a good thing the government is taking over health care. They'll straighten things out. I'm sure of it.