Lactategate

I have written about the unnecessarily labyrinthine health insurance system before, but the recent birth of my second child presented me with two rather vivid examples of the institutionalized inefficiency I have come to loathe.

As a part of my health insurance policy, my wife is entitled to a single consultation with a certified lactation consultant per pregnancy. She conducted diligent research and finally located an in-network facility that employed a lactation consultant accredited by everyone except the American Dairy Association.

The session was informative and we congratulated ourselves on taking advantage of this benefit with no out-of-pocket cost. So imagine my consternation when I received a bill for the appointment because insurance had declined to cover it. With my coverage book in hand, I called the nationally-known provider that administers my insurance in order to bring this error to their attention.

Once on the phone with an associate, they explained to me that while I had gone to an in-network facility and been seen by a properly accredited lactation consultant; the clinic had coded the bill incorrectly. I responded that I have a copy of the bill and it clearly states “lactation consultation services” were rendered. From there the conversation continued thusly:

Her – Yes, but they did not code it as a preventative services visit and all lactation consultations must be billed in this manner. You will have to call the clinic back and have them submit a corrected claim.

Me – That seems rather illogical since the purpose of the visit was to facilitate lactation not prevent its occurrence.

Her – I am sorry sir, but we cannot pay it unless it is coded correctly.

Me – This was not a colonoscopy or mammogram. The only condition this visit could have prevented is inefficient lactation. Can you honestly tell me that lactation consulting is a preventative service?

Her – Let me place you on a brief hold

*** 10 minutes pass******

Her – I spoke to my supervisor and it appears to have been a billing glitch. It will be paid within two weeks.

I fully understand the need to guard against fraudulent claims, but this bordered on obstructionism. The insurance provider could clearly see that my wife was pregnant and that we were billed by an in-network provider for the very service my policy covered. If the claim was submitted under the name of a 75 year-old man and the service was rendered by an accountant, I could understand the scrutiny.

Unfortunately, this was only the beginning of “lactategate” since my next task was to obtain reimbursement for a manual breast-pump. My health insurance policy will not cover an electric breast-pump unless my newborn is placed in the NICU. Otherwise, they will only cover a manual model. Thankfully my child was born without complications, so I ordered a manual breast pump from Amazon and logged into my provider’s website to locate the reimbursement forms.

Still unable to find the form, I called and spoke to an associate. After asking me if the breast-pump in question was for me or someone else on the policy, they informed me that the only way to obtain reimbursement would be to take a blank sheet of paper, attach the receipt, and write my Subscriber ID, Wife’s full legal name, and her birthday. I was then to place this piece of paper in an envelope and send it to a P.O. Box at the other end of the state. I would hear something back in six weeks.

Uncomfortable dropping an identity-theft starter kit into a mailbox, I asked again if there was a more efficient way to complete this process and was told no. I hung up and called back the next day in order to get a second opinion. Our conversation went something like this:

Me – Are you telling me, that in the year 2015 a company with a website that allows me to see the processing of E.O.B. claims in real-time and has a corresponding smartphone app cannot allow me to submit a claim form on their website?

Her – I am sorry sir, I do not know what to tell you.

Me – How is that even possible?

Her – Well, it is a security and privacy issue….

Me – Wait, so you are telling me that your website is not secure but you are uploading my HIPAA sensitive records to it?

Her – Let me place you on a brief hold…..

**5 minutes pass**

Her – Why don’t you just fax the info to this number and it should be scanned into the system by the close of next business day. Is there anything else I can help you with?

Our system becomes more and more complicated with each passing year. In 2013, the not-for-profit organization that administers my health benefits plan was left with a $256.2 million surplus despite spending almost $1 billion in “Administrative expenses and broker commissions.” This roughly equates to $83 extra for every human they cover. Undoubtedly, they would argue that this money was re-invested into the community or retained as a legally-required surplus; and that is a reasonable counterpoint since medical costs are so unpredictable.

Why are they so unpredictable? The birth of my child will generate at least 5 separate events at no fewer than 4 private medical billing organizations (all of which will take a cut). The hospital will generate two separate bills for the child and the mother, while the anesthesiologist, OBGYN, and pediatrician will all file claims for the same event. That is why an amused chuckle is the only answer you are going to get if you ask someone in the medical community how much a textbook vaginal delivery costs.

No single entity can really see all the moving parts and even the ones that come closest (like my insurance carrier that often benefits from pre-negotiated contracts with providers) are still forced to pad their coffers with obscene surpluses. At the close of 2013, my provider’s surplus was over $740 per covered individual and growing. Perhaps this is a microcosm of why an average of 30% of the money American’s spend on healthcare is absorbed by administrative fees and bureaucracy.

I Wish I Drank Coffee

I wish I was a coffee drinker. I love coffee cake. I love the smell of coffee beans. I love the way a coffee-making apparatus looks on the kitchen counter. I love the mystique surrounding it. I believe that coffee is one of the greatest social accessories available to humanity. It is cheap, ubiquitous and provides a universal conversation piece. It has been utilized in religious ceremonies and banned for political strategy. Despite all of this, I cannot get past the fact that it tastes like rainwater from a rusty steel can that someone used to soak their bunions.

I have been informed again and again that “it is an acquired taste” but life is too short to try and convince my taste buds that they need a second opinion. I never had to convince myself that BBQ ribs or ice cream was delicious. I did not have to force-feed myself bacon for years before I could appreciate its culinary power so why should I keep ingesting caffeinated brown water until my senses relent? At any rate, one does not have to be a coffee drinker to appreciate the benefits of being a coffee drinker.

Coffee Drinkers Appear Contemplative – When you see someone gazing toward the horizon with a cup of coffee in their hand we tend to assume that they are agonizing over life-altering decisions or the profundities of human existence. We even feel guilty for approaching someone during these moments as if we have intruded upon a private ceremony. The slow and purposeful movements of the coffee drinker do seem almost ritualistic; their faces constantly enwreathed by steam.

Of course, this is all a facade created by the beverage. They simply needed to pass some gas and the window was far enough away from their cubicle to provide plausible deniability were it to linger. The truth is that coffee drinkers ponder the same things that water enthusiasts or pork-rind connoisseurs do, they just look better while they do it.

Sipping Coffee Buys You Time – We have all been there. You are at a family reunion or social event and find yourself running out of discussion topics. Maybe this is the first time you have seen your nephew since his stint in rehab or one of your wife’s co-workers just announced that her husband was sleeping with their dog-sitter. Do you comment on the weather? Stare at your shoes? You need to think of an out or fake an emergency but nothing comes to mind.

Coffee drinkers never have to panic in these situations because not only can they simply cover their face with their cup, they can leave it there for a full 2 minutes before anyone suspects a thing. That is because coffee is meant to be consumed slowly. It is hot and could melt your face. People expect your sips to be long drawn-out affairs. Try and sell that with a bottle of Dasani. You can only fake-drink so long before people notice that the amount of water isn’t being significantly reduced and they realize that you are stalling.

Coffee Provides An Excuse for Morning Hostility – You can get away with almost anything as long as you make it understood that have not yet consumed your morning cup of joe. Sorry I called your mother an alcoholic financial leech honey, but I hadn’t had my coffee yet. I shouldn’t have thrown a dead bird at those nuns officer, but we were out of Folgers at the house. 

It Is An Unassailable Excuse to Eat Pie – No one will ever judge you for eating a large slice of pie as long as you have a cup of coffee in your hand. While the rest of us will be indirectly accused of gluttony (I am stuffed. I don’t know how you have room for that!) no one is going to disparage you cramming an Edwards in your face as long as you have some coffee.

Coffee Allows You to Create an Identity – If I see a grizzled man with a beard ask for black coffee with no frills, I naturally assume they are a no-nonsense, salt-of-the-earth laborer who could probably tell you more than one story that involves a bar fight. That’s the implication is when someone says “I’m a black coffee man.” You expect a low-maintenance self-reliant personality. I would be taken aback to see someone fitting that description order organic hazelnut French-roast because it suggests a love of poetry and at least one delightful summer spent studying abroad.  

Chiropractors

While speaking to a family member this Christmas, I learned of a fascinating wellness philosophy: the use of chiropractic treatment as a substitute for traditional Western medicine. My wife is a chiropractic patient and has been for years, but had foolishly limited the scope of her care to problems involving her spine. As it turns out, there is a growing number of people who believe that a properly-trained chiropractor can successfully treat or mitigate a staggering number of ailments ranging from influenza to ADHD by correcting “vertebral subluxation.”

I began doing some Internet research on this approach and quickly found myself on the website of Chiro-One Wellness Centers. Chiro-One is an Illinois-based chain that offer extensive chiropractic care for a variety of conditions. The site lists a number of afflictions and how chiropractic care treats them.

ADHD - By correcting nerve interference, function is improved, with greater expression of human potential. Many report terminating drug therapy, and seeing the personality, will, and soul of the child unfolding.

I don’t know what you are getting in exchange for your co-pay, but I can assure you I have yet to leave the pediatrician and experience the “unfolding” of my child’s soul. That is not to say that we should ask hyperactive children to ingest large amounts of pharmaceuticals without cause, but how exactly does one quantify “greater expression of human potential?” Could I sue for malpractice if my child gets an adjustment and their grades plummet?

Aging - Chiropractic care frees the body from a serious form of health-damaging stress called the vertebral subluxation complex that causes premature aging by destroying vitality and weakening our natural healing ability.

Just once I would like to see an episode of Law & Order where the medical examiner lists the cause of death as “vertebral subluxation” so I could hear one of the investigators toss off a one-liner like “and I thought my back was killing me!” Does this mean the Benjamin Button’s spine was overly aligned? 

Ear Infections - Children with ear infections need chiropractic adjustments. In many cases ear infections are observed to disappear after chiropractic care, saving children from ear-tube surgery and antibiotics.

I’m afraid I will need to some peer-reviewed medical research on this one. What does “observed to disappear” even mean? What is the time period we are talking about? I could easily correlate two unrelated events given an ambiguous amount of time like if I said or “his childhood stutter has not been observed since he graduated college “or ”I haven’t contracted malaria since I pooped at an Exxon.”

PMS and Menopause - Doctors of chiropractic help see that the sexual organ/spinal column relationship is a healthy one. Chiropractors correct the vertebral subluxation complex (a dangerous condition in your spine that interferes with the nervous system and causes a state of “dis-ease” or reduced health and wholeness) that can lead to disease.

While I have no issue with my wife seeing a chiropractor, I am not sure how I feel about another man asking her if he can check the health of her “sexual organ/spinal column relationship” in exchange for money. That situation could place me in a state of “dis-ease” and it sounds more like a pick-up line than the clinical language of a diagnostician.

Cold and Flu - Keeping your body free from vertebral subluxation keeps your natural immunity high and could make the difference between a quick recovery and lingering illness. A spinal exam can change your life.

Here they have clearly gone to simply listing a viral infection and making vague references to “vertebral subluxation” and lingering illness. The website lists 27 separate maladies that can be “helped” by chiropractic care but after really looking into this I am afraid they have sold themselves short.

Here are some suggestions to add to the website which are ambiguous enough to infer treatment while avoiding litigation.

Ebola – Preventing vertebral subluxation fortifies the body’s natural immunity while helping mitigate the discomfort of hemorrhagic fever. 

Racism – It has been suggested that proper spinal alignment correlates to an increased acceptance of ethnic and cultural diversity.

Marital Infidelity - When we allow our biomechanical spinal segments to stray we often find that our hearts do the same.  

Bankruptcy – Many report that an increase in chiropractic adjustments correlated to an eventual decrease in phone calls from collection agencies.  

Unemployment – Study after study confirms that the gainfully employed are six-times more likely to be under the care of a chiropractor than their unemployed or homeless counterparts. Coincidence? We think not.