Personal health care timeline.

December: I visit the doctor and tell him I have acid reflux and have had it since I was a teenager. I tell him I've learned to live with it and have improved my situation by maintaining a healthy diet, staying active, and taking Omeprazole. He says that's all well enough, but fifteen years is a long time to be suffering from the same heartburn. I can't disagree with that, and I'd really prefer to not have to take medication every day, so we schedule an appointment with a GI specialist.

January: The GI specialist tells me I should have an upper endoscopy done. United Healthcare tells me that will cost me $300 ($200 deductible plus $100 copay). I ask the specialist how necessary this procedure is. He says it's imperative that we get my quirky digestive tract figured out once and for all. Again, there's no way I can disagree, so we schedule the thing. Every step of the way I'm asking someone else, "So this isn't going to cost more than $300, right?" All answer affirmatively. At Hoag Memorial, I pay the $300 up front before they anesthetize me and shove a tube down my throat. A week later, the specialist calls me back to tell me my results. I have acid reflux, he says. I should continue my current dietary practices and keep taking Omeprazole. For a split second I consider channeling John Goodman's character in Barton Fink and exclaiming, "I said that already, you should pay me $300!" But I don't. I've learned to see doctors and hospital billing departments as co-conspirators in one big swindle, and largely consider my own interaction with them as a gamble. I treat it like blackjack in Vegas: I only took $300 to the table because that's what I was prepared to lose. At least I know I won't lose anymore.

March: I receive a letter from Pacificare telling me that they're denying payment of my January claim. Upon calling, I find out that the whole thing was somehow billed to a no-longer valid Pacificare account I had when I worked at a bank many years ago. I give them the correct account number and they tell me not to worry about it.

April: I get two new bills: one for the facility and one for the IV drip. The former is for $640, the latter for $212.10. I call on both in a panic, and the representatives tell me that--though they're now at least working with the right insurance company--they still have my account numbers wrong. I give them the correct account numbers and, again, they say it's all taken care of.

June: I get the same two bills. I call on the $640 and magically upon the customer service rep hearing my voice it gets reduced to $38. I don't understand how I owe $38, but at least it's not $640, so I just pay it. The $212.10 is more complicated. United Healthcare says they never received that bill, despite it saying in bold type "INSURANCE DENIES CLAIM." I call Newport Pathology, and am told that they did bill United, but that my account was canceled in 2002. That's impossible, I say, since I didn't even get this account until I started grad school in 2007. They ask for my account number. I give it to them. They say it's not valid. Yes it is, I say, and every other office has taken it except yours. Am I reading it off the card, they ask. Yup. Is that the policy number? No, it's my subscriber number--policy number is... Oh, well, that's the number we submitted before that got rejected. Makes sense, I say, since you're the only ones who ask for that number. They say I need to tell United that they actually did get the bill but that it was rejected mistakenly. So I call United again (each of these calls involves at least a ten minute wait) and they repeat that they never received the bill, adding that Newport Pathology probably doesn't know how to bill student insurance accounts, which have a different number of digits than regular ones. I get a fax number to give to Newport Pathology and call them again. I explain the whole thing, insist that the person on the line take down all the numbers on my card despite her insistence that I'm reading my card wrong and that there must be a nine-digit subscription ID or policy number somewhere (seriously?), and give her the fax number to contact United. She tells me I can call back in two weeks to find out the status of the claim. I tell her I'll be out of the country by that time, that the whole point of getting the fax was supposed to be that it would be taken care of immediately. That's the best she can do, I'm told. I grumble a halfhearted thank you and hang up.

Here's what really gets me: despite a persistent condition that requires minimal attention, I'm healthy. I don't think it would be right to whine that a visit to the doctor confirmed that I'm in good health, which is why I didn't complain about the initial $300. But I would not have agreed to the procedure if it had cost $1100, or even $500. Furthermore, this isn't the first time I've had to deal with this sort of thing. In fact, it happens more often than not with my insurance. This is an insurance plan, by the way, that doesn't cover physicals and whose doctors appear to have no interest in preventive care. Why does this bother me so much? Because cancer is extremely common among men in my family. As I approach my thirties, I would like to be able to get myself checked in the necessary ways before turning up with lumps and weight loss and lethargy. But in addition to not being insured for that sort of thing, I don't trust these glorified drug dealers, and I have neither the money nor the time to do this dance every time I have a question or concern. So I just don't go to the doctor, and though I know it will eventually bite me in the ass, I don't know what else to do.


image: Marriage à-la-mode III: The Inspection, by William Hogarth (1743)