Something To Say

My letter to Congress, I don’t just complain on my blog

khurley54 — Sat, 06 Mar 2010 14:35:52 +0000

It’s a fact that the US is ranked 37th in health care quality according to the World Health Org, and that we spend more on it than any other country. Clearly not good. The Pew research center has shown that different groups of people view the quality of our health care system differently. Lower income groups as well as Democrats seem to see the reality of the state of our health care quality. Republicans and higher income groups still think the US is above average in health care quality. Could there possibly be some disparity between the info our Democratic leaders are telling us and the info the Republican leaders are feeding their constituencies? Based on these facts it would seem that somewhere on the right the leaders are not fulfilling their obligation of keeping their constituents adequately informed and dare I say they are even manipulating them into being fearful and in denial?? This has to end, Democrats are trying to send a clear message but it needs to be clearer. We are now seeing Blue Cross and Tufts and Harvard Pilgrim intending to increase rates by double digits in MA?! How can our small businesses afford this? The insurance companies say that Dr.’s rates are going up as well as costs, but what about the rest of us? We all have to pay more for everything, and we aren’t getting any more income, sales aren’t going up for small businesses, and more jobs will be lost with the increased premiums. I am deeply concerned about the polarization this issue is causing around the country and our leaders need to come together and provide clarity, not fear. Facts are facts. We can disagree about how to go about it, but we can’t demonize the other side and scare one group of Americans into thinking another group of Americans are evil and trying to ruin the country. It’s clear that reform is urgently needed, and the alternative to no or little reform is what is actually scary.

Everybody look what’s going down

khurley54 — Fri, 26 Feb 2010 15:17:30 +0000

I follow a lot of news sources on Twitter. I like the 140 character no wiggle room limit for each tweet. I hate watching the news, in fact I never watch it, because of all the spin that inevitably ends up on what should be the most objective and straightforward source for all us Joe Schmoes. They do want ratings after all. I wrote a research paper for a class a few years ago explaining how the news media does us a disservice by paying more attention to stories with “elements of human drama”. Yeah, they report what they think we want to watch, not just what happened. It’s a soap opera spin. You’ve seen the teaser, complete with drastic photos and a very urgent, brooding voice, “A band of ruthless, insane, murdering pirates leave a trail of destruction as they pillage from town to town, find out if YOUR neighborhood is next, at 11″ and you look at the clock and it’s only 7 and you panic a little, then think to yourself I better just stay right here and wait till the news comes on. I don’t know about you, but I don’t like being tricked into watching the news and I don’t like being scared.

But I just got a gazillion tweets about impending doom.

Local news update: Storm causes power outages, raises concern about
Freetown dam – http://b.globe.com/aKxAGh

Storm knocks out power to at least 700,000 homes and businesses in
northeastern U.S. – AP http://twitter.com/BreakingNews/status/9677893910

Winds, rain leaves 100K in Mass. without power – http://b.globe.com/cjdd7t

Iceberg the size of Luxembourg breaks off from glacier in Antarctica,
could affect ocean circulation patterns http://bit.ly/a2EGTj

9.4 inches of snow falls on New York’s Central Park, breaking previous
daily record of 7.5 inches set in 1874 http://bit.ly/dAalUx

Local news: Flooding concerns as storm pelts region – http://b.globe.com/9bMJ7G

Northeast braces for third blizzard within month http://on.cnn.com/biggF1

Now, I don’t want to anger anyone, but I get a little bothered when people rush out to buy guns for protection because of the constant barrage of news stories about kidnappers and escaped convicts and rapists all over the place. There are bad people everywhere and really bad things happen all the time and putting more guns into the hands of more people is not going to change that, but make it worse. It’s an example of an alarmist reaction that is really detrimental. If ya wanna get all alarmist, go for global warming.

Global warming is a topic that a few years ago when I wrote that paper illustrated the height of the disservice our news media is providing us. By failing to sufficiently report about it due to lack of “drama” (people apparently are more drawn in by stories about murder and rape than they are about dying polar bears) and by providing equal weight to the skeptics who have absolutely no basis in science and are a very small isolated group compared to the entire scientific community around the world, they really make it seem like it’s no big deal. No planet, no problem! Let me say this, global warming is not a threat to the planet but a direct and serious threat to the human race. This planet will be here looooong after we are gone. It does not care what the temperature is, how much ice there is, how many floods there are or what animals die. But we should. We need the planet to stay in a state that is conducive to our survival. And we are tipping the scales and altering that state to a point where we won’t be able to survive here. I think that is grounds to be pretty alarmed, and we need to feel that urgency. But we must also stay positive; we can change this, but we need to do it now and as quickly as possible.

And how? Cooperation.

There are so many ways we have been told we can help. Recycle, cut back on energy use, cut back water use, call Congress, etc. Honestly sometimes the best attempts have backfired. Some hybrid cars are made in plants that have higher pollution rates than other car plants. Using plastic bags, come to find out, has less impact than using paper (less energy used and pollution emitted to transport them). Well, that’s frustrating. We need large-scale, big time, national, international change. Legislation, policy, restrictions, direction. And these are very slow processes. Why? Because nobody can go with the flow, I’m tellin ya that’s why. Look at our country, every time you have a proposal trying to do something so obviously good and beneficial for the entire country (ahem, healthcare) you always have a bunch of people bitchin about their rights and freedom and “don’t tread on me”, and I mean from all sides of the spectrum. I’m all for freedom and protecting our rights, I feel strongly about that, but sometimes I feel a slight undercurrent of selfishness in all that. Is there a line to be drawn? Freedom doesn’t mean we can just do whatever the hell we want, there has to be a sense of responsibility to our fellow-man that comes along with that.

So back to ruining our planet. If we don’t put our own selfish desires aside, we will become extinct. That’s my 2 cents.

Check out Newsvine

khurley54 — Fri, 06 Nov 2009 17:51:39 +0000

Look at me on Newsvine!

Be careful, Newsvine is so addictive. It’s like twitter for news articles. I have some of my blog posts published. You can go vote for me and move me up the list!

William Shatner reads Levi Johnston’s Tweets

khurley54 — Fri, 06 Nov 2009 17:16:19 +0000

This is too funny. William Shatner is a genius.

Check Out Mike Capuano’s New Commercial!

khurley54 — Mon, 02 Nov 2009 15:21:16 +0000

Debate tonight

khurley54 — Mon, 26 Oct 2009 18:48:06 +0000

Don’t forget to watch the MA Senate candidates debate tonight at 7pm! I’ll be out there on Mt. Vernon St in Dorchester around 5pm for the debate rally and watch party at 7 with fellow Capuano supporters. Come down and join us if you’re around. I have been lucky enough to be one of Mike’s constituents here in Somerville, and I can’t wait for the rest of MA to see what a great speaker he is and how passionate he is about working for us.

A Taste of the Status Quo Continued….

khurley54 — Mon, 26 Oct 2009 14:20:58 +0000

AND, one of the biggest insurance companies in the country has a really bad habit of processing claims incorrectly. For NO APPARENT REASON a huge percentage of claims submitted to this particular huge insurance company are processed as “out-of-network”. What this means is that instead of paying the 65 bucks they are contracted to pay, they deny countless claims stating that the provider is not in their “network” and therefor the patient is responsible for paying the charged amount at 100%. Even if this was your deductible, it wouldn’t be 100%. Saying that you have to pay 100% means your insurance company has turned their back on you; washed their hands of you; kicked ya when you’re down. So, where they would only have had to pay 65 bucks, you get to pay 140 bucks. But, guess what, the provider is in the network, was never out of it, doesn’t plan on leaving it. So, why, how, did they make the determination that the doctor, nurse, therapist that you saw was out of the network? No one knows. Call them, they don’t know. Their supervisors don’t know, their regional directors don’t know, their network managers don’t know, their provider relations representatives don’t know either. God himself does not know. How can we prevent this from happening? Well, according to this insurance company the billing office for your doctor (me) can go to ridiculous lengths to make sure that the people in the claims processing department at your insurance company that are getting paid with your premium dollars to do a certain job, do this job correctly. I have literally been advised by “high-up” people at this insurance company to write a letter and attach it to each individual claim, and there are a lot, specifying the fact that the provider is in the network, the manner in which they are contracted (group vs. individual vs. facility), and providing information that is already available on the claim form in the manner in which they mandate. That is like me going to a store, picking out an item to purchase, and bringing it up to the register with complete instructions for the sales person on how to complete the transaction. It’s like me doing that because their manager told me to do that instead of providing training. I guess that money that you pay to your insurance company every month goes into some one’s pocket instead of towards adequate training for their employees. Or maybe it’s just some sick cosmic joke. Anyone else need a drink?

A Little Taste of the Status Quo

khurley54 — Sun, 25 Oct 2009 20:48:29 +0000

I work in Medical Billing, and have been in the field for about 4 years. I have done billing for 3 different providers and corresponded with probably every insurance company in the state of Massachusetts as well as a slew of others across the country. I think that medical billers are seen as the people who send out bills and statements to the patients and call you if you don’t pay your doctor’s bills. And yes, sometimes that’s true. But for the most part, we are the people who make sure your insurance company pays for your doctor’s visit; we make sure that your doctors receive the correct reimbursement and that you get billed the correct amounts according to your deductibles and copays. We make sure that your claim gets to your insurance company and gets adjudicated correctly. We understand all the technical jargon and red tape of the insurance industry that makes the whole realm of third-party reimbursement so mysterious to most people. It’s exhausting keeping up with these insurance companies and playing their game just to get fifty bucks for your doctor’s visit. I like job security, but I don’t like feeling like a monkey jumping through hoops; I don’t like having to follow their flagrantly unfair rules of the game and not being able to do anything about it.

My point is that the insurance industry is beyond ridiculous. This is why I am so passionate about reform, because everyday I have to fight them tooth and nail to get medical bills paid at their pitiful reimbursement rates. We have to go to great lengths for small amounts of money for people who went to medical school, spent years and hundreds of thousands on education, who have life saving skills, who help people in the most drastic sense. It is a complete circus to get these doctors and other healthcare providers paid by the insurance companies. People say they don’t want the government in control of their healthcare, but right now we have corporate CEO’s controlling it with profit being the only thing in sight for them, making millions from the sky-high premiums we are paying while receiving so little in return.

I have a few real-life examples of this game; these are from my experience in working in third-party reimbursement. I will not mention the providers, patients or insurance companies involved, I just want to give you a little taste of the status quo.

Every insurance company has what is called a “filing limit”, which is the amount of time you have to submit a medical claim to the insurance company. There is no standard for this, every insurance company is different. The most common filing limit is 90 days, but some are 60 days, some are 150 days. And if they do not receive the claim before their filing limit, too bad about ya; you get nothing. The funny thing is that very frequently medical claims that are sent in somehow just mysteriously vanish into thin air and therefore miss this important deadline. I have had this happen more than once. Example: I have 5 claims that I need send into an insurance company and since they are all going to the same place I put them all in the same envelope. After some time, I see that one of these claims has not been paid. So I make a call to the insurance company and I am told that the claim was received some time ago, but not processed and I need to give it more time. There is no reason given for this, and here is unfair rule #1- healthcare providers have to adhere to filing limit deadlines for claims submissions, but insurance companies can take their sweet-ass time paying us. So after 2 weeks I call back, speak to another person and they cannot find the claim. If I’m lucky I get to speak to their supervisor and no, it’s not there, they never got it. Now I am over their filing limit. So what was that first person looking at when they told me it was there, give it more time? How the hell did the other 4 claims that were mailed out that day, in the same envelope get paid? What happened to this one? Can I get someone to go down to the mailroom and rummage around? Nope, sorry, nothing we can do.

A word about speaking to supervisors at most insurance companies…..this is a rare “treat”. The vast majority of the time that I ask to speak to a supervisor, preferably who speaks English and/or knows what they are talking about, I am put on hold for 30 minutes, then told that they are not available and will call me back. I can count on one hand the number of times I have received a call back from a supervisor. If I was previously in an accident involving explosives, fireworks, electric saws, I could still count on one hand the number of times they have called back.

Now say they receive the claim, they pay the claim, and then oops! I realize we had the wrong procedure code (we billed for a 30 minute visit and it should have been 60 minutes). Hey, it happens. The way we monitor our accounts, any mistake like this is always found. Now, I told you about the initial claim filing limit, but to make the game even more fun we have a slew of other time limits for any kind of correction, adjustment, resubmission, etc. and again, every insurance company is different! This one insurance company in particular has an initial 90 day filing limit. If you need to make a correction, you then have only 60 days from the time that they either paid or denied the claim. So, if you do the math, you can see that it is quite possible to submit a claim, receive the denial, and still be within the initial 90 day filing limit, but over the 60 day limit for corrections. Amazing right? Mind blowing. If you can’t wrap your mind around that one, ask me, I will be more than happy to elaborate.

I am going to stop there for now. I will certainly have more examples to come, I have tons in mind at this second. But I want to get this posted so people can start to see where I’m coming from.

Massachusetts Residents are the best!!!!

khurley54 — Tue, 20 Oct 2009 23:44:49 +0000

I am just having the best time calling my fellow voters and rallying up their support for reform. I have been making calls since 4pm, with a pizza break I snuck in there for a bit, and have spoken to so many great people. They have been asking me so many questions about what’s going on right now on the issue and I have had so many people willing to participate by calling their representatives in Congress. I get a lot of people who are saying it’s pointless because they know Massachusetts Senators and Reps are going to vote for reform and support the President’s plan, but then when I tell them that the number of phone calls are being tracked nation-wide and we are trying to get as many calls as possible from all over the country to show the amount of support out there from every state, they are all about it! This has been a fabulous night so far, and I have more phone calls to go, but thank you to everyone who is helping out, listening to me, and picking up the phone.

Call Congress!

khurley54 — Tue, 20 Oct 2009 19:45:56 +0000

Today is the day we are trying to get as many people as possible to call their reps in Congress to push for real reform. I’m about to make my calls to them, and then I will be calling constituents to try and get more support. Even though I’m from Massachusetts and my reps are on the record for supporting the reform, I think it’s important for everyone to make a call so they can see just how many of us out there want this. The latest update is that we have over 100,000 callers so far; I would say that’s some pretty good lobbying! We can send a message that is louder and clearer than insurance lobbyists, so pick up the phone and help out!