Working the System?

We can probably all agree that healthcare costs in the US are simply out of control. As an experiment, I recently tried to develop a way to have my health insurance pay for my blood tests in preparation for an upcoming appointment with my Functional Medicine MD (FMD). Here's how it went:

First, I requested and received a coded list of the necessary tests from my FMD. Easy, except that I have no idea what the codes mean. Maybe a code AND a name might be more helpful? Sure, I can look them up on the World Wide Internets, but is that my job?

Next, I contacted one of the major testing labs to check their price against what my FMDs provider had quoted, which was $375. The testing lab I was working with "had no way" to check with insurance to see what would be covered and couldn't even tell me what the out-of-pocket cost would be. I had to make three phone calls, and I never received any answer. Funny. I could've sworn that I contacted "Customer Service."

I booked an appointment with my testing lab, fully expecting that I would leave there without being tested. I went to their facility, and they had no appointment record. Lucky for me, they could take me as a walk-in. I did find out, however, that the out-of-pocket cost would be "around" $4,500 if insurance wouldn't cover it. Again, I was told to contact insurance to determine what they would cover. I wouldn't sign to take responsibility for the costs, so no tests.

Having given up on that approach, I tried something else; a message to my Primary Care Physician (PCP). We pieced together my existing recent labs and ordered some that were needed to address other issues. Hopefully, my FMD has everything he needs for my appointment next week, but we'll see. Getting the PMP and the FMD to actually talk to each other has been a challenge on several issues, so it's been left to me to manage this process.?

I could go on endlessly about how this all could be improved.?

This nonsense took me several hours to sort out, and I'm still not convinced that I have it right. Where do I send the bill for my time?

It seems relatively straightforward. My insurance is paid an obscene premium amount (TWICE the average amount spent on healthcare per person in comparable countries, BTW) to provide me with care. However, they have set up rules that benefit their company and put up roadblocks at every turn, with little regard for the patients. Something has to change, and it will.

Please share your experiences in the comments...

–jk