Copay Confusion (Or: I Hate Insurance Bureaucracy)

I got a call from my wife. "I picked up the mail and there was a check from the hospital for two thousand dollars."

Um...okay.

Ordinarily I wouldn't question it. I'd cash it and we'd have a fun weekend away, especially with a three-day weekend coming up for us.

But seeing as this came from the hospital that a little over a month ago had cut me open and knowing that my copay for the operation was two grand, I thought this was a little too good to be true.

I called the hospital. "The insurance company paid your bill from us in full, so we mailed you the difference."

"They paid in full?"

"Yes. All paid."

Oooh...what was that feeling? Hope? I didn't eat yet...so it can't be an overeating pain, or a pain from something too dry trying to fit through the food hole of the stomach...must be hope. Much needed money!!

But still I've been alive long enough to know that these things don't happen to my family.

I called the insurance company and explained what happened. The nice service rep checked my benefits and information on the procedure, and came back and confirmed that yes, they paid the facility bill in full.

"In full?"

"Yes. But we're processing the provider's bill. It can take up to two weeks..."

"You paid the facility bill, but not the provider bill?"

"Not yet. We're processing the claim. So your copay may go to the provider, the surgeon. You should hold on to the check for two weeks until you get the explanation of benefits..."

Ow, ow...ow...oh, that feeling just drained away. Now I don't know if it was hope or gas.

This is a wonderful example of user-friendliness. To me, the end user, I owe money to some monolithic entity, the hospital. We give them money, they disperse it as necessary...I assume they employ the doctors and whatnot.

Apparently this implies that doctors are like consultants working for the hospital and as such there's two or three times more paperwork that snakes through insurance companies and the hospital, making it much harder to keep track of anything. This also means that two or three months later I'm still getting papers trickling in saying what is owed and what's paid and not paid.

I had paid my copay ahead of time so avoid hassles. Instead I've created another hassle for myself. @#$%#

Ideally the insurance would pay what's needed and the process would be streamlined to the point where I wouldn't need to track all these various places money is owed and who got what. I'd have a form or website for "medical" that would state where to send money, authorize the transfer on a certain date, and fwoom, done. I could get an instant update on where the money is and the status of bills, and maybe even have a link that I could click to send queries to service reps about questions.

It would be a wonderful idea but because of the bureaucracy involved in trying to get insurance companies and hospitals and doctors to work together it would be a monumental undertaking. I'd have better luck finding a way to get a live webcam broadcasting from the moon.

Anyway I'm now going to cash the check, set the money aside again, and wait until the bill comes so I know who to pay and my dreams of having a brief, relaxing vacation has been dashed as quickly as the hope rose in my chest. Or the gas. I'm still not sure which it was.