WTF 2/1/2024

One more time… Capitalism sucks…

Before I get to the meat of this week’s column…

For anyone thinking capitalism is doing us all who are not among the 1% of the 1% any favors…

• UPS just announced that they made $90 billion in 2023 and the company still fired 12,000 people to cut costs.
• McDonald’s CEO was paid $17.8 million in 2022. It would take a typical McDonald’s worker more than 1,200 years to make that amount.

The Affordable Care Act pays for preventive care… yet insurers still bill we the people…

When the Affordable Care Act… aka Obama Care… went into effect in 2010 the preventive care measures that were regularly prescribed to be performed with patients by general practitioners and other medical professionals were supposedly covered in full except for maybe small copays.

“Supposedly” is be included here because a recent Washington Post investigative report and article says things are not always what they are said to be.  

The Post found many patients received rather significant bills when they were assured that the preventive care they were receiving was covered under the Affordable Care Act (ACA).

They article in fact included various examples in their published article…

A 46-year old man in Texas, went to his primary-care doctor for his preventive-care visit which he done previously at no cost. And the visit was paid for by his insurer, but he got another bill for an additional $111.81. The bill was generated because the insurance company said when his doctor asked if he had any health concerns, he mentioned that he was having digestive problems but had already made an appointment with his gastroenterologist. And the visit to his primary care doctor was now both a covered preventive care visit as well as a non-covered consultation.

A 50-year old man in Virginia got insured under the ACA and went to a new primary-care provider to take advantage of the preventive-care benefit despite the fact he had no physical complaints. He asked for assurance that everything was covered by the insurance when he went in to the office for the checkup and got that assurance from the doctor’s staff.  And his insurer paid the bill for the checkup, but he hit him f0or another bill for a “new patient visit.”

A 46- woman in Minnesota who happens to be a colorectal surgeon, went in for a screening colonoscopy and was billed for a biopsy of a polyp… a bill she knew was illegal der to the fact that Federal regulations issued in 2022  are very clear that biopsies during screening colonoscopies are included in the no-cost promise.

And just last year when a woman went in for her annual mammogram in Washington… as in the state and not D.C. … she thought the test was covered in full due to the fact it is one that is listed as covered according to the provisions in the ACA that encourages we the people to use screening tools that could nip medical problems in the bud to keep us healthy… or at the minimum head off any burgeoning medical issues before those issues became medical disasters sucking away whatever finances we rely upon to pay for our daily expenses and live in relative comfortable circumstances.  

Yet it came to pass one day she opened a notice from her insurer for a bill that said she owed $236. It so happens that this woman works as an occupational therapist familiar with the health-care industry’s workings and she bitched to her insurer and the hospital and was told that the test was covered but the fees to use the equipment and the facility where the test was done were not

This answer pissed her off to no end especially since only a year earlier, her “free” mammogram at the same health system had generated a bill of about $1,000 for the radiologist’s reading. That she had fought and had had a decision rendered back in her favor eliminating the debt. However this time around she resigned herself to forego the cost involved in her time to fight the powers that be and wrote out a check to pay the bill.

But she did write out a letter to the KFF Health News Bill of the Month project that the author of the Post article works and said in that letter that the bill was absurd and that “This is not how the (ACA) law is supposed to work.”

And in fact the writers of the ACA did assume they had covered their bases by spelling out with what they believed was sufficient clarity that millions of people subscribing to the health care law would no longer be on the hook to pay for certain types of preventive care, including mammograms, colonoscopies and recommended vaccines, as well as visits to their doctor to screen for disease.

The problems arise because those writers of the law didn’t take into consideration the insidiousness of capitalism and the ever-creative medical industry’s billing offices to figure out how to get around the law and have patients get billed for various other finagled costs involved in providing what was supposed to be covered preventive care by the medical profession to we the people.

The Washington Post article says that the “problem comes down to deciding exactly what components of a medical encounter are covered by the ACA guarantee. For example, when do conversations between doctor and patient during an annual visit for preventive services veer into the treatment sphere? What screenings are needed for a patient’s annual visit? A healthy 30-year-old visiting a primary-care provider might get a few basic blood tests, while a 50-year-old who is overweight would merit additional screening for Type 2 diabetes.

Making matters more confusing, the annual checkup itself is guaranteed to be ‘no cost’ for women and people age 65 and older, but the guarantee doesn’t apply for men in the 18-64 age range… though many preventive services that require a medical visit (such as checks of blood pressure or cholesterol and screens for substance abuse) are covered.”

So what is thought to be covered by our doctors and other medical professionals who are providing us our preventive care is not what ultimately winds up looking the same to insurers looking to squeeze out whatever they can from we the people’s wallets and pockets by whatever means that they can “legitimately” do so.

Adding to the confusing accounting BS is this from Ellen Montz, who is the deputy administrator and director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare & Medicaid Services, who when asked for an interview to discuss the insurance industry’s creative billing practices she sent an email that included the following statement…  “If a preventive service is not billed separately or is not tracked as individual encounter data separately from an office visit and the primary purpose of the office visit is not the delivery of the preventive item or service, then the plan issuer may impose cost sharing for the office visit.”

Meaning that the doctor decides that a patient’s mention of stomach pain does not fall under the umbrella of preventive care, then that aspect of the visit can be billed separately, and the patient must pay the cost for that “consultation.”

Montz also added: “Whether a facility fee is permitted to be charged to a consumer would depend on whether the facility usage is an integral part of performing the mammogram or an integral part of any other preventive service that is required to be covered without cost sharing under federal law.”

And the author of the article reasonably asks… “But wait, how can you do a mammogram or colonoscopy without a facility?”

The article goes on to say that “Unfortunately, there is no federal enforcement mechanism to catch individual billing abuses. And agencies’ remedies are weak — simply directing insurers to reprocess claims or notifying patients they can resubmit them.”

Leading to the conclusion… “The stories we receive at KFF Health News are likely just the tip of an iceberg. And while each bill might be relatively small compared with the stunning $10,000 hospital bills that have become all too familiar in the United States, the sorry consequences are manifold. Patients pay bills they do not owe, depriving them of cash they could use elsewhere. If they can’t pay, those bills might end up with debt-collection agencies and, ultimately, harm their credit score. (And) Perhaps most disturbing: These unexpected bills might discourage people from seeking preventive screenings that could be lifesaving, which is why the ACA deemed them “essential health benefits” that should be free.”

Which brings me to ask this…

What would happen if this country’s politicians… our elected representatives in Congress… passed a bill authorizing “Medicare For All”?  

Y’all think this accounting bullshit from the insurers would be stopped in their tracks due to the fact the insurers themselves would no longer be needed once a  “Medicare For All” bill was passed  and then signed into law by whoever was the presiding president of the United States of America?

Just another reason to go Blue and Progressive as possible in 2024.  

Another thousand words…