I know more about getting a homeless person with mental illness medical and mental health services, covered and paid for, than my own.
Turns out, there’s a simplicity that comes with relying on DSHS health plans, public clinics and state and county supported hospitals. Not so for those with some funds, and insurance.
I ended up in the ER (Swedish Medical Center Ballard) a couple months ago with what turned out to be a DVT. I knew my insurance covered the hospital, and my doctor referred me to the local ER, just a few blocks from my house. Last Friday I received a bill for the Ballard Emergency Physicians, the people who treated me (and gave about 15 min of face time) for $550. No insurance coverage, except for the “maximum allowed amount” of about $150.
The billing service that sent me the bill was helpful – they let me know that though they got the name of the person billed wrong, that the problem was with the insurance (Premera Blue Cross) and the physician group. Turns out that though the facility (Swedish Hosptital Ballard) is covered by the insurance and is in-network, the physicians that work in the ER (Ballard Emergency Physicians) are contracted, and have their own insurance preferences, in this case, NOT PREMERA.) This means that a person can be in a state of emergency, taken to the nearest emergency room, have coverage for being in the facility, but not for the treatment.
When I asked the insurance how to avoid this problem in the future, she suggested to “call ahead.”
I spoke to a supervisor with the billing service for the physicians group. Not surprisingly, she laid the blame on Premera, saying that they’re well aware of this kind of thing going on, and that this is an increasing trend at hospitals to cut costs. Others have commented that there is also rampant greed with the physicians groups, in addition to difficulties with wrangling with Premera themselves.
It’s a sick system, really. One that I was previously unaware of. I know I’m lucky that the amount I’m being charged, ultimately, is only $300, which is chump change compared to what some people walk out of the ER with. However, it’s offensive to me that once you past that threshold into the ER, you have no choice of seeing a provider that’s covered by your insurance (let alone, lab services, which are an additional contract out!)
There needs to be health care reform. It’s ridiculous that the systems I’ve navigated for indigent clients are simpler than the systems I’m navigating for myself. Profit and cost-cutting get in the way of the bottom line of getting people medical care.
And I’ve looked at an independent party’s ratings of the Swedish system compared to UW and Harborview for relevant conditions – they might have top of the line technology, but their outcomes are worse than expected. What are they spending money on?
Pardon the disjointed rant. For once I’m not doing as thorough a job as I try to for this blog. 
