Will the New Healthcare Bill Make the System Suck Less Than it Does Now?

My daughter received her BS at Dartmouth College, in June of 2004. She planned to go on to receive her Master's degree, but wanted to take a year off to look for work. As stated in our healthcare provider's coverage brochure, our plan would cover her until September of 2004, at which time it would end if she did not attend school fulltime.

As (bad) luck would have it, two weeks after graduation, my daughter slipped off the curb on the campus of Dartmouth, where she was currently working in the Music Library. She was in a lot of pain and decided she should go to the emergency room on the medical center on campus. Once there, my daughter handed the receptionist her HMO insurance card, and the receptionist reassured her that everything went through just fine.

The technician took X-rays of my daughter's ankle, and discovered it was only a sprain. They wrapped it in an ace bandage and sent her home with instructions.

A few weeks after the ER visit, my daughter received bills from the medical center, totaling over $600.00 for her ER visit. Because the bill indicated that the center billed her twice for the same X-ray, she called believing that the insurance company refused to pay for this obvious error, knowing the technician took only one X-ray that night.

The receptionist explained to my daughter that one charge was for permission to perform the X-ray, and the other was for the actual X-ray. Amazingly enough, my daughter accepted the preposterous explanation that one bill came from the medical center, and the other one came from the clinic. These buildings are all part of the same complex.

Before I go on to the reason the clinic and the center billed my daughter instead of the HMO plan, I would like to express my thoughts on what I saw happening at the time.

Someone is definitely making money in the medical profession, as I have discovered now on several occasions. Pediatricians can charge for procedures they never performed. Clinics, medical centers, hospitals, and doctors can charge twice for one procedure, one for permission to do the procedure, and one for actually doing it. Sounds like one of those "get rich quick" plans. Unfortunately, you need a medical license to practice, in non-technical language, what I see as medical insurance fraud.

To return to the mystery of why our healthcare plan did not cover my daughter's medical expenses, the medical center receptionist told my daughter that our medical insurance provider informed them that she was no longer covered under our plan.

I wondered how that could be. Then we remembered the procedure we had to go through to continue my daughter's coverage under our plan. Once we realized it, we had an idea about what happened. The following is an outline of the procedure we followed for every year my daughter attended school past her eighteenth birthday.

Every year, my husband's employer gave him a form called a Student Verification Form. This form has three parts, one part filled out by my husband, another by my daughter, and the third, by the Registrar's Office at Dartmouth College, the school my daughter attended.

We knew that somewhere among the many hands that touched this form, the information must have been either lost or ignored. We also imagined we never would have found this out if my daughter had not slipped off a curb.

After what happened the first time around with my daughter and the pediatrician, I was willing to find out for her what was going on. Additionally, after having just recently winning a battle with the credit bureaus, another area where fraud and waste runs rampant, I was not only ready for it; I looked forward to it. I was ready to battle with anyone who gave me an unsatisfactory answer, or who even talked to me the wrong way.

I called my medical insurance to ask why they did not extend her medical coverage until September of that year, as they were obliged to, and they proceeded to tell me that they did not know why. Angering me further, they told me to contact the Registrar's Office at Dartmouth and to have them send a statement telling them that my daughter was a full-time student up until two weeks prior to the incident. The woman at the HMO told me that my insurance covered my daughter until at least September of that year. Ignoring the fact that I just said that to her, I did what she suggested.

I called the college and the Registrar's Office told me they had no record of signing a form for my daughter that year, but that she would immediately fax the necessary information to our provider. Two weeks passed and the provider still had not updated my daughter's status. When I called and asked if they received the information from the school, they actually told me that they did, but did not get around to updating it.

Feeling like my head was going to explode, I found out just two days later that the medical center sent my daughter's unpaid bills directly to a collection agency. I called them next and asked them why they would do that, when my daughter told them I was clearing the matter up with our insurance provider. All the receptionist could manage to say to me was that the collection agency would probably report the unpaid bills directly to the credit bureaus and that it could damage my daughter's credit report.

Furious, but not concerned about the credit bureaus, I hung up the phone. I knew how to deal with them and with creditors as well. As I explained, I just finished dealing with their fraud and deception.

My immediate concern was that the medical center was on the campus of an Ivy League college, with former students, which to me if not to most people, meant that they were smarter than most of us. Sadly, it took this experience to find out otherwise.

Not only did my daughter graduate from the same college where the medical center is located, she was also currently employed by the college. She was still living on campus. Smarter is not a word I would use to describe them ever again.

Nevertheless, people of below average intelligence hold down all kinds of jobs. For example, it took over two weeks for someone in the office of my HMO healthcare provider, to read a fax from my daughter's college. It then took another week for someone to transfer this information into the computer. It took me less time than that to clear up my daughter's credit report. Perhaps data entry is too much to ask of her nation's healthcare provider employees. American definitely needs reform in the healthcare industry, in more ways than we want to know.

I have since taken it upon myself to type up generic letters of complaint and when I need to use them again, all I have to do is fill in the blanks. Between my two experiences with only one of my children, I assume my daughter may need these forms for any grandchildren I may one day have. They may decide to go to college with all the other smart people.

These blank forms contain the following:

• (name of) Healthcare Provider
• (name of) Medical Center
• (name of) Clinic
• (name of) Registrar Office
• The AMA*

* The organization I like to refer to as "The Big Help".

These are the possible reasons for sending the forms:

• HMO Healthcare Provider- for all the paperwork and the process these papers go through to get someone who is already entitled, covered under my medical insurance
• Medical Center - for charging over $600.00 for an Ace Bandage
• Clinic - for not knowing that "if you can move it, it ain't broken", but continue with the X-rays, and for charging twice for the same procedure, and getting away with it!
• Registrar - for failing to fill out the form and stamping it (a lot of work for some apparently) and mailing it back to the healthcare provider
• AMA - to report HMO, Medical Center and Clinic (see reasons above)

After not receiving a response eighteen years ago from the American Medical Association when I reported a doctor for committing insurance fraud, you would wonder why I would bother trying again. I only know it will make me feel better to tell them exactly what I think about them and that I know exactly what is going on with our healthcare system.

I cannot say whether the new healthcare reform bill will make any of this easier, because I do not have time to read a bill containing thousands of pages. I would like to think that the new healthcare system has to be better than what we have now. On the other hand, maybe it will only get worse from here on out.