Every time I use my health insurance card, some one steals from me.  This isn’t a figure of speech.  This isn’t me exaggerating.  This is the cold hard truth.  This isn’t something that happens in Puerto Rico, or Florida, or Texas.  It has happened everywhere I’ve used my Cigna card.  And frankly, this isn’t even something specific to Cigna.  When I had Blue Cross Blue Shield, it was the same thing.

Follow me through how I used my insurance twice in the span of a week and a half, and got over charged a total of $1700, while EVERYONE from the tech, to the doctor, to the health insurance company took a bigger slice of the pie they were entitled to.

First, some background.  My insurance covers one free physical a year, so I usually partake in this luxury.  And while I was out (I don’t get out much), I decided to check the repetitive strain injury I have acquired from years of typing.  Yano hooked me up with an unnamed colleague of hers specializing in hands, so I decided to visit two doctors in one day.

Since we are relatively healthy, we have a high-deductible health insurance plan with a health savings account (HSA).  Which means that the first $6000 of the year are on us, and it comes out of our HSA account.  This is the only reason I notice when we get overcharged, because I see the balance instantly diminish on mistakes.

A few weeks after my visit I got an explanation of benefits from Cigna in which I saw a total of approximately $3000 that came out of my HSA.  WTF?

THE PRIMARY CARE PHYSICIAN

The primary care physician ordered $400 worth of labs.  I had to call him and ask for a complete break down so I could follow up with Cigna.  The physician even charged $25 for walking the blood, literally, across the street to the lab.  Of course, they chose the most expensive lab.  Though, I can’t fault them, because considering the proximity to their office, I can understand the convenience.

As is usually the case, the primary care physician is at fault for very little of what actually gets charged, but is nevertheless responsible for some…

A few calls to Cigna revealed that because the labs were out-of-network, they had paid the entire amount (out of my savings account).  I explained that I went to an in-network physician, and they proceeded to adjust the claim.  Savings: $400.  In reality, however, I could’ve gone to any number of labs across the city to get my CBC and lipid panel done for a tenth of the cost, saving my fellow Cignites copious amounts of health insurance premiums– but that’s a separate problem.  In reality, the lab over charged, the plan over paid, and the physician didn’t have the common sense to send the lab to a more economical place.  This is what’s called in economics, moral hazard: the cookie jar ain’t mine, so I don’t care who takes the cookies.

THE ORTHOPEDIC SURGEON

Upon entry to the orthopedic surgeon’s office, my HSA credit card got swiped, as a “precautionary” measure, just in case my health insurance didn’t cover enough.  The secretary then informed me I needed to have an in-house X-ray.  I politely explained that I had no broken bones, and that I was coming for a repetitive injury I had had for a decade.  The secretary insisted.  I explained a possible neuropathy of the ulnar nerve, to which I got a glazed look, and a repeat of the obvious– “you need an xray; it’s standard procedure”.  I stood my ground and told her “if after I see the doctor, he would like me to get an x-ray, I will do so”.  That was the end of THAT over-billing, or so I thought…

Weeks later, the ortho’s office calls me and informs me that they are reversing a $300 charge, for something they over billed.  Whuuut?  I was told that they over billed “just in case” my insurance wouldn’t cover everything, and that they were reimbursing me $300.  I got suspicious and went back to my HSA statement, where I found that not only was I over charged $300, but I was billed twice for $97, and some neurologist I had never met charged me $1970.

Being the cool cat that I am, I decided to ignore the $397 I was over-charged, and concentrate on the $2000 on my bill.  To my surprise, the ortho’s office had no idea who this neurologist was.  After some detective work I realized it was the neurologist that read the nerve conductivity test (EMG) at the ortho’s office.  Ironically, the ortho’s office disassociated themselves from the neurologist and claimed they didn’t know who he was, and were in no way associated with him– that they only rented out the space to his staff.  Fair enough, I would call him directly…

THE NEUROLOGIST

I had a nerve conductivity test done by a lab tech, with 20 year old equipment.  The procedure required $5 worth of needles, lasted 15 minutes, and the neurologist who never saw me, charged $1970.  Fair enough, I work from home.  I applaud working in your underwear.  What didn’t make sense was the $1970.

The explanation of benefits from Cigna showed 4 labs and 3 supplies.  Since I called another neurologist friend of mine, I knew the needles didn’t cost more than $5, so I couldn’t wrap my mathematical mind around $100 worth of “supplies”.  Cigna couldn’t tell me what the individual charges where because of “privacy” concerns.  They said I must call the doctor’s office directly and ask them.   Hmmm… so here I am, getting charged $1970, and the entity (Cigna) who took the money from my account can’t even tell me what it’s for.  So…

After much googling, I find a suitable phone number, and call the neurologist.  I explain my predicament, but they have no record of me.  I am told I will be called by the billing department, but after a week, I receive no calls.  I call them multiple times, and eventually break down and tell them I will call my insurance company, say the charges are fraudulent, and reverse the charges.  I get a call back within 5 minutes.

They had no record of me.  No one could explain why they had charged what they charged.  At one point they wanted me to send them my explanation of benefits, to which I politely declined.  If they didn’t know what they charged me for, I sure as hell was not going to make it easy for them to make shit up.

Eventually I got a call back from the outsourced company who did their billing, who found that the doctor had indeed received a payment for $1970, but due to some “unexplained” reason, the payment had bypassed the office altogether.  The billing company told me not to worry because my insurance had paid everything.  I explained the way high-deductible plans with HSA’s worked and how it had all come out of my savings account.  Silence on the other side… All of a sudden, the caller turned apologetic and said $1970 was way too much, and that they would resolve this with the doctor’s office.  So wait, $1970 is way too much if a human has to pay for it, but if a health insurance plan pays for it, then it’s ok?

Eventually I got on a conference call with the billing company and the doctor’s office, who at one point asked me if I had had a sleep study done.  At no point would they tell me what they had actually billed me for…

To make the long story short, they are in the process of reimbursing me well over half of what they charged.

Conclusions…

Total saved by numerous phone calls $1,700.

The frustrating thing is that I had to hunt down billing departments, medical plans, doctor’s offices, and at one point I had to physically get the copy of the doctor’s order requesting the EMG.  This by no means is within the realm of say, my grandmother, when she visits the doctor.  And this all happened within a week.  And this happens every fucking time I use my health insurance card.

This wasn’t at all weighted on the neurologist’s side.  Everyone involved tried to take a bigger slice of the pie.  Fortunately for the neurologist, he had a broader variety of procedures he could charge for.  But every single entity involved from day one bit as much as they could take in, in one mouthful.

The MD’s shall remain unnamed, because I think it would be unfair for me to single any of  them out, when EVERYONE is doing this shit.  The entire system is broken, and has evolved into an over billing fiasco.  The labs are over paid (when they get paid).  The doctors are over paid (when they get paid).  The hospitals are over paid (when they get paid).  When the cookie jar is open, every one will grab some cookies.  Unfortunately, there is enough overhead, and enough groups of people (rich and poor) not paying, that it offsets this over payment for the providers involved.  But this doesn’t make it right… it’s wrong, and it’s broken.

And if you think it doesn’t affect you because you have a low deductible– surprise, everyone else on your plan is picking up your slack.  We all pay for it– either in higher insurance premiums, or in higher taxes (medicaid/medicare), or any combination of the above.

It is such a big pity that the last four years were spent with Republicans bitching about Obamacare, instead of offering an actual counter proposal that would actually work.

Oh that both sides could work together for the common good.  But as long as everyone that is reaching into the cookie jar is lobbying in congress, there will be no respite.

The exercise dictator decided to take it easy.  I only had to run 7 miles before a breakfast of coffee and toast.  What I didn’t know was that it would be followed by a Free Walking Tour of Krakow (which I was told, is not pronounced “Crack-hoe”). The walking tour was quite enjoyable, and I only starting feeling dizzy at the end of the 2.5 hour walk. Unfortunately, it was so good, that the boss decided to do another walking tour, this time through the Jewish Quarter of the city. This is how another 4 torturous miles started. To add insult to injury, we were so late to catch our next train that we had to jog another 2 miles to the train station with 50 lbs on our backs (damn heavy laptop).

Obviously, we collapsed after pretty much an entire day running, jogging, or walking, all on a few slices of toast and a quick lunch at McDonald’s. I’m sure I’ll need no sleeping pills on the flight to London…

It’s amazing how much sightseeing you can do if you cover 6-8 miles before the throng of tourists gets out.  You see, I’m accompanied by the exercise Nazi who is awake at the crack of dawn, running shoes on, and not taking no for an answer.  So now instead of walking tours, I’m subjected to a running tour of the city centers and ancillary streets, while other sane people on vacation are sleeping, or at worst sitting half asleep in a picturesque coffee shop.

I’ve run the streets of Vienna, Budapest, Prague, and an assortment of other smaller towns.  And if Yano had her way, we would’ve done a couple laps around the Auschwitz-Birkenau concentration camp, as would be fitting her non-negotiable running nature.  Luckily, the Polish were not as amused at a whip wielding wife forcing her husband to run at slightly above anaerobic pace.

In other news, we are in Krakow, Poland, having done a tour of the Auschwitz camps.  I am not much of a tour or museum person (with the exception of the Louvre, the Uffizi, and the Cairo Museum), but the visit to Auschwitz will take your breath away.  If there is anything that made this entire trip worth it, it was those 2 hours and 45 minutes.  Words cannot do justice to it.  Suffice to say, that it was the first time I saw a groups of hundreds of people speechless for an entire afternoon.

Last week we spent a wonderful 3 days with Marcela and Peter, two couch surfers from Bratislava, Slovakia.  Slovakia is a beatiful country, and we were happy to see it mostly devoid of the throng of tourists that plague Vienna and Prague.

Peter and Marcela were kind enough to show us around, and even take us to a handful of places outside the usual tourist path.  It was an exquisite treat to hear first hand accounts of the communist era, as well as second hand stories from the various wars of the 20th century.

Yano and I are big fans of couch surfing, mostly because of the rare opportunities to peek into the lives of locals the world over.  Even though today, there’s almost nothing that can’t be surmised from a cursory view at wikipedia and google images, couchsurfing offers something that hotel traveling cannot.

It is something to read about life behind the Iron Curtain, it is quite another to see the twinkle in Peter’s eyes as he recounts the first time he went to Vienna, just a few kilometers away, but on the

other side of the curtain.  He told us about the bright colorful displays in shops with a variety of items, to contrast with grey colored shops with nothing but two types of soaps in Bratislava.

It was quite fascinating to hear about vacations to Yugoslavia, which was even poorer, and having lines of people stand behind their car every time they opened their car trunk, because folks thought it was an ad-hoc black market.

All in all we had a wonderful time with our hosts, and were sad to continue our journey back into Austria to visit one of Yano’s schoolmates in St. Polten.  But alas, that is also another adventure in our rear view mirror, and we’re on a train to Budapest, Hungary, where rumor has it, there is a plethora of Indian restaurants.  My diet officially starts tomorrow…

Ok, that’s better than “I am a Weiner”, which may be more apropos to Vienna but far more risible…

I think most of what we call cultural differences can be summarized in differences in communication styles.  I seem to frequently trip over them as I cross cultural divides, both in my personal and professional lives.

Today we crossed over to Austria in search for hidden Mozart treasures in Vienna.  On the train ride over we met a young Spanish couple thoroughly confused at the Czech-English instructions being doled out by the attendants.  After the usual “where have you been and where are you going” we decided to tag along since they had a better thought out plan with regards to accomodation.  The clever reader may infer “cheaper price per night” and would stand uncorrected :).

We arrived in Vienna, and after much fumbling about, arrived a few stops outside the city center.  Our new found friends had reserved an actual hotel room for 40 euros, which clearly beat our 40 euros for a hostel (and this with breakfast included!).

I asked for a room, and the clerk said 90 euros.  I looked back puzzled and inquired as to why my friends had booked for only 40 euros.  He said, “internet booking 40 euros.  Here 90 euros”.  Trying to be clever, I replied… “do you have wifi?”.  “Yes, here is wifi password.”  “Can I book online?”.  “Yes, here is site to get cheaper price”.

Unfortunately everything was booked, and Yano was upset as to why we couldn’t get the cheaper price.  So we looked around on google maps and decided to meander over to the city center and at least get something more centric.  Right before leaving, I politely asked the gentleman “I can’t find the cheaper price on the internet.  Can you help me?”  He browsed the aforementioned website for a while and replied “Oh, I see.  Internet booking all booked up.  Sorry.”.

All of a sudden I clicked my German communication translator and decided to give it one more try… “Would it be possible to get your internet price but book in person?”.  He stared back nonchalantly and replied “of course, no problem.  That will be 40 euros.”

It may seem funny, but I still get tripped when dealing with eastern European engineers, because I feel I haven’t perfected the art of asking the right questions in a language that is equally understandable to both parties.  You see, it’s not that the man was being difficult, it’s that I clearly didn’t know how to ask the right questions.  I’ve been bitten (no pun intended) by this many times, and I’ve obviously not gotten the hang of it.  But at least now I try not to get frustrated, cause I know it’s mostly my fault.

And in the Germans’ defense, they’re not alone on this.  There’s an entire profession of people that think and communicate similarly… they’re called engineers (and all of their affiliates) :-).