I Hope They Never Find Him

I saw a pulmonologist at the Post-Covid Recovery Clinic at Rutgers in February. When I made my $40 copay, I forgot to tell the hospital to submit the bill under my wife’s policy; I’d lost my own health insurance because I was too sick to work. (Thankfully — I could still be covered.)

The insurance company paid the bill by accident. Or rather, they paid $176, the amount they apparently considered appropriate for a 20-minute telehealth appointment with a medical resident and his supervisor. A few weeks later, they realized their mistake, called the hospital, and asked for their money back. 

The hospital got in touch with me: you owe us $842 dollars. Their price for the appointment, including the copay, was — IS — $882 dollars, if you’re paying the bill without insurance company mediation.

I asked them to rebill under the correct policy. They did. 

— Insurance company: that policy expired.

— Hospital billing office calls me back: your policy expired.

— Me: no, it didn’t. It’s current.

— Billing office: the insurance company says it expired.

— Me: …

— Me: … 

— Me: … what policy identification number was it billed under?

— Billing office gives me the number. It checks out.

— Me. That’s the ID number for the current policy. It’s not expired.

— Billing office: Oh. Well … you need to appeal the denial with the insurance company.

At this point, I should have gotten my butt in gear immediately. But I was already negotiating with the insurance company over several other issues.

• I’d been trying for months to get reimbursed for appointments with an out-of-network therapist. The therapist made a mistake on the bill, the insurance company rejected it. My job: find out from the insurance company what had to be on the bill; explain it to the therapist; get the bill from her; fill out a new claim form; send it to the insurance company.

• Another doctor’s office, another $40 copay. And then they ran my credit card for another $127. Why? “the insurance company says you have a deductible.” The doctor was in network. There was no deductible. I had to contact the insurance company and get them to pay the bill — and then get the doctor’s billing office to refund me the money. (I still have to check my bank statements and see if that money ever came back.)

• Long Covid messed up my vision; things double and blur, my eyes snap in and out of focus, the more tired I am, the worse it gets. The folks at the Long Covid clinic sent me to an occupational therapist who sent me to a neuro-optometrist who did a bunch of tests and prescribed glasses that helped … some … but it cost me $2,000 out of pocket. Insurance company: nah. 

And in the middle of trying to work through all of that, I had some kind of allergic reaction. I still don’t know what triggered it. 

My neck was so puffed up I felt like a toad trying to look big and unappetizing, my ankles and fingers were swollen, and I was short of breath; then I started having chest pain. The GP sent me to the ER, where they checked my blood pressure, listened to my heart, drew blood, looked worried … and repeated the procedure every hour or so. Eventually they found me a bed so they could keep waking me up all night for  more blood draws and more blood pressure readings. 

(I hate that cuff on the blood pressure machine. It’s so tight it makes my fingers tingle, every time.)

Morning. Someone brings breakfast for the lady in the bed next to me; I realize it’s been 24 hours since I called the GP. Could I possibly get some coffee? Nope: no food or drink until they can get me in for a nuclear stress test. Noon rolls around. 3 pm, the resident on the floor says I can have ice chips. 

Reader, I cheated. I let the ice melt and then gulped the water down.

Soon after, an orderly appears to wheelchair me to the test, but it was another two and a half hours before I could eat. 

The upshot: my heart is fine. They have no idea what’s wrong with me, but I’m not going to drop dead of a heart attack, so … I can go home.

Eventually I persuaded my GP to give me antibiotics. (I’ve ridden in this rodeo before.) I started to recover. Slowly. Many, many weeks of slow recovery, punctuated by functional capacity testing that left me even worse off.

Remember that bill I mentioned a few paragraphs upstream? It’s in collection now.

Since February, I’ve seen several other doctor in the same system as the Long Covid clinic. The billing office, instead of crediting those copays toward those visits, applied them to the bill for February. So in their minds, I’ve paid them $440.

Between my copay and the $176 insurance forked over, they called the bill settled for $216.

I’ve already paid $264 more than that. But they sent the bill to collection to scrape another $442 out of me. As much again as I’ve already paid. More than four times what the insurance company will pay.

Oh, and those other copays? The ones that they credited to this bill? Now I’m fielding phone calls about those. 

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On average, health insurers deny 17 percent of claims. United Healthcare, the biggest health insurance company in the United States, rejects claims a third of the time.

During the three-year tenure of the CEO who was assassinated two days ago, profits soared from 12 billion to 16 billion. 

I’m not proud of it — but yeah, I’m rooting for the guy who shot that CEO and hoping he manages to disappear forever. 

If Car Insurance Were Disability Insurance

Insurer [let’s call the company Mutual Farm]: Explain the nature of the car accident, the resulting damage to your car, and a detailed explanation of what makes it so that you cannot drive it in any situation. Arrange for reports from the police and your mechanic to be sent to us directly. Provide contact information for the police officers and anyone else you have consulted about the damage to your car.

The form is twenty-seven pages long (but page nine is only for signatures; pages ten through twenty-six contain fraud warnings for each state; you have to sign again on page twenty-seven to acknowledge the consequences of providing fraudulent information. It is emailed to the Car Owner as a PDF (neither searchable nor editable) to be printed and filled out by hand. There is insufficient space after every question to provide the requested information.

Car Owner submits requested documentation, with seven attached pages providing answers to all of the questions.

Eight weeks later …

MF: We have more questions. We tried to call the police. We only make one phone call, this is our policy. They have not called back.

P: We called the number they gave us three different times. No one ever picks up the phone.

Mechanic: The car is totaled.

MF: We need a complete description of all disabled systems with the OBD-II codes resulting from the scan.

M: The scanner doesn’t give any meaningful data. The engine can technically turn over, but the frame is cracked, the chassis is bent, the oil pan has a hole, and there’s leaking coolant.

MF: What’s the maximum speed you could drive the car in an emergency?

M: That would be a terrible idea. It would be dangerous.

MF: How far could the car be driven?

M: It can’t be driven, it is dangerously broken.

MF: But you just said the engine runs. So the car works.

M: Technically… yes, but the car needs all kinds of repairs to the body before it’s safe to drive it.

MF: We will need the details on that from the body shop.

O: Pays to have car towed to body shop.

Repair shops are governed by state law; body shops are governed by federal law.

MF: You’re going to have to submit a new claim to our body-shop division. Here’s the form you have to fill out.

It’s thirty-two pages long, and is effectively the same as the form you filled out in the first place, but the questions are phrased differently and are posed in different order. You have to fill it out by hand again, attach seven typed pages with the same information as last time, but in a different sequence and referring to different page and question numbers.

MF: *crickets* 

Owner calls MF to find out why no action has been taken. 

MF: We have not received the form.

Owner resubmits. Two more weeks go by.

MF: It went to the repair shop division. We found it and now the body shop division has it.

Auto Body Specialist: We can try to straighten out the bent chassis, but it might get broken in the process; the frame would have to be replaced because the cracks can’t be fixed; and the oil pan has to be replaced. Those alone would cost $12,452 in parts, plus labor and oil. We would have to check the entire engine for damage because it was hot when the oil leaked out, and we would need to inspect the cooling system to figure out where it is leaking and determine what repairs are needed.

Six weeks later (three and a half months after you filed the claim). You’re exhausted and broke from walking to the supermarket and Ubering to work. There is public transit, but the trip (a 35 minute drive) would take four hours on three buses and a train.

I: We can’t make a determination on your claim without a complete estimate.

O: Pays the body shop for seven hours of labor to check the engine and the cooling system.

S: The car is totalled. It will require $17,952 in parts to repair, plus labor.

I: What’s the labor cost? We can’t make a determination without full information.

S: That depends on how long the repairs take.

I: Give us an estimate. The maximum pay-out will be the amount of the estimate minus 10 percent because we can.

Two weeks later …

S: It will take three mechanics seventeen hours to straighten the chassis, one mechanic thirty-seven hours to disassemble the entire car from the frame and two mechanics an additional twelve hours to attach a new frame. Two hours to inspect the cooling system, two or more hours to repair whatever is leaking; ninety minutes to replace the oil pan.* Additional parts and additional labor may be needed, depending on what the detailed inspection reveals.

I: Our independent mechanic read your notes and says you should be able to straighten the chassis in four hours and weld the cracked frame in three. Plus the engine still runs. Is there anything preventing the car owner from turning it on?

S: The engine turns on, but if anyone drives it, they would get hurt when the frame or chassis eventually break completely. 

Seven months after Owner filed the claim.

I: Your car works fine. There is no evidence in your claim to the contrary. We’re unable to provide insurance for this incident. You can appeal this decision within the next 180 days. It is your responsibility to assemble all the documentation and submit it to us in a single package, along with a letter explaining why our denial of your claim was in error.

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*I made up these numbers. But I didn’t make up how hard it is to get disability insurance, even though in terms of numbers and costs, fake disability claims are a tiny fraction of all insurance fraud.

graphic: 1greenblogger | data: CAIF

 More than 60 percent of disability claims are denied, even though less than one percent are fraudulent. 

Across the rest of the insurance industry, widespread fraud and cost the industry and the US government $308.6 billion in 2020:

• 10 percent of property claims are fraudulent
• 3 to 10 percent of health insurance claims involve fraud (but insurers deny 15 percent of claims)
• more than a third of people admit they filed false claims for car and home repairs
• 20 percent of people lie on applications to get cheaper car insurance, and 30 percent to cut home and property insurance
• 16 percent of workers compensation claims involve fraud (pdf, page 18)
• 20 percent of life insurance policies are revoked because insurers find lies on applications (pdf, page 33)

For perspective: private insurance companies collect more than $1 trillion in premiums every year. That’s twelve zeroes. $1,000,000,000,000. More than the gross national product of Switzerland.

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update: 1:05 pm ET, 12/4/24