Navigating your way out of the “labyrinth” of medical bills

Lin Osborn is a graduate of the Health Advocacy Program whose passion and profession is helping people “navigate” their way around the health insurance system. Today, Part IV in the New York Times’ series, “Being a Patient,” included the following story about a family facing an extremely serious illness of their two year old—and a morass of medical bills that made no sense. Reporter Katie Hafner, tells the story this way:

In late 2003, Bonnie MacKellar's son Elias, then nearly 2, stopped eating. Then he stopped talking and walking. Elias had stage IV neuroblastoma, a highly malignant tumor of the nervous system.

Though pushed to their emotional limits, Ms. MacKellar and her husband, Thomas Dube, refused to buckle until the bills started to appear in the mail each day: hospital bills amounting to tens of thousands of dollars; invoices from doctors she did not remember meeting; E.O.B.'s from her insurance company that explained nothing.

"It is hard to describe what it is like to be confronted with mounds of scary claims and bills when you have a 2-year-old who is extremely ill, who needs constant nursing and doesn't have a great chance of surviving," Ms. MacKellar said. "And to sit in a hospital room, on hold with the insurance company for 30 minutes or more only to have your child start puking just as you get a rep on the line."

The E.O.B.'s seemed to serve little purpose beyond engendering fear. They were detailed enough ("radiology services 2/19/04"), but when it came to understanding the boxes listing the amounts charged, the amounts not covered, the fees allowed, the available benefit and the remark code (IT, 29, and the ever-mysterious QN ), Ms. MacKellar and her husband were at a loss.

One statement that said, "Plan pays $00.00, patient pays $56,750.00," caused panic. The remark code "07" stated, "These charges are for services provided after this patient's coverage was canceled."

There had been no cancellation of coverage, but convincing the insurance company of that fact was an ordeal.

The breaking point came when the group number on the health plan changed, and Ms. MacKellar was unable to convince the insurance company that it was billing under the wrong number.

In despair, she consulted a social services agency, which put her in touch with Lin Osborn, a private consultant fluent in the arcane language of health care billing. For a fee, Ms. MacKellar was told, Ms. Osborn could take all the paperwork off her hands.

An expert in deciphering insurance and hospital billing codes, Ms. Osborn spent several days straight working on the case and took care of the entire mess, Ms. MacKellar said.

We are glad that Lin founded Health Plan Navigator to advocate for people facing these problems; but Lin would be the first to say that we need to address the reasons why people who are coping with sickness also have to be coping with billing and insurance harassment. Frankly, it is hard to imagine anyone who has gone through this not thinking that a single payer national health insurance plan has to be a better way. It is hard to resist concluding with the question of why “close to 30 cents of every dollar spent on health care goes for administration, much of it spent generating bills and explanations of benefits.” (Basic Medicare--our single payer national health insurance for the elderly--by comparison, spends around 3 cents on the dollar for administration.) Hafner suggests that this 30 cents “keeps the system churning.” I think we need to ask who benefits from this churning. Surely not the patient.