Minuteman Health’s online terms

Recently I signed up with Minuteman Health, and I began the registration process so I could automate my payments. When I came to the terms of service, I read them more carefully than usual, since they could affect my insurance agreement. That was a good thing, since I came upon this:

V. The User shall: … 4. Keep confidential all information that he or she obtains from the Site, including, but not limited to, information about Minuteman Health’s business practices, providers, or rates of payment to providers.

That means I wouldn’t be allowed to talk about how well I’m covered, what doctors are in their network, or how what sort of service the company provides online. I immediately backed out and wrote a check. Using Minuteman’s online services under those terms is simply unacceptable, and it doesn’t give me a good feeling about the company.

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Your doctor doesn’t care about you

Recently I had routine outpatient surgery to remove a scalp cyst. I’ve had a number of these done before, so I didn’t consider it a huge deal. Today, though, I got a bill telling me that my insurance covered less than half the cost, and I owe hundreds of dollars. This is annoying because on the one hand, the options for avoiding these situations are few, but at the same time I wasn’t paying attention. While I was working at Harvard I had top-class insurance coverage, which meant I never owed more than a few dollars, and I got careless. I still have insurance, but it’s a lower level of coverage.

The problem is that our health care system has turned into one where the patient isn’t the doctor’s customer or even the insurance company’s customer, but the product. Lopsided tax incentives, and now Obamacare’s tax on the uninsured, pressure everyone to get insurance from their employers if at all possible, and laws require that they provide very broad coverage. People believing that they’re entitled to have their medical bills paid (the recent righteous demands for mandating birth control coverage are a case in point) add to the push. Today I talked to someone who told me his health insurance should be free. I said, “You want me to pay for it.” He said, “No, I mean free!” Magical thinking is America’s leading political philosophy.

Doctors assume you’re covered by insurance and don’t take the cost into account when making referrals. The doctor who performed the procedure is a plastic surgeon; if I’d been thinking more carefully, I’d have realized that would mean a large bill and asked some questions. For the cyst before that, I was in a hospital operating room, with an anesthesiologist standing by doing nothing, but I was at Harvard at the time and my insurance paid everything but a token copayment. Or maybe the insurance compensation was so low because the doctor performed the procedure in his office instead of an operating room and I’d have been better off financially with the full surgical team. It takes a greater expert than me to know. In any case, the lack of economic connection between patient and payment have made costs rise at escape velocity.

Have you ever tried to get a quote from a doctor? I need to push harder for that next time, but from what I’ve heard, it’s impossible to get one that’s more precise than a factor of ten between the low and high ends.

For me a bill that size is an inconvenience. For people with no income at all, they may not get great treatment, but their bills will be paid for. The people who get squeezed the worst are self-employed people with low incomes, such as a lot of musicians. It’s not uncommon for them to get stuck with huge bills that threaten to ruin them financially. Upper middle-class progressives have driven medical costs up with their “I wannit” philosophy, and the people in the lower income brackets get hit hardest.

I need to learn how to ask the questions that doctors don’t want to answer. It has to be possible to grab some measure of control back, even if it takes a lot of work.

How not to get screwed by Harvard Pilgrim

Here’s the tl;dr version: If you need to terminate health insurance which you’re buying yourself, first stop any payment, then talk to the insurance company. You’re in a much better position if they don’t already have your money.

Here’s the story: In late July I started a new job. Its benefits include health insurance through Harvard Pilgrim. Before this I’d had been paying for my own insurance in a COBRA arrangement from my earlier employer, Harvard University, also with Harvard Pilgrim. Crosby Benefit Systems administers it.

My new insurance card was slow in coming, and I didn’t feel safe cancelling my old insurance until I had the new card in hand. That was a mistake. By the time I had it, the August payment had been deducted from my checking account. Crosby told me, after I provided the needed information, that my insurance would be cancelled. What they didn’t tell me was that it wouldn’t be cancelled till the end of the month; I only found that out when I got a letter over a week later. This means that for five weeks, I’m paying two premiums to the same insurance company for the same coverage. Harvard Pilgrim has hundreds of dollars from me that pay for nothing.

I contacted Crosby. They told me they couldn’t do anything about it because those are the terms that Harvard puts on its insurance. I contacted Harvard Pilgrim. They told me that the money is collected by Harvard, not them (they just happen to get it from Harvard), so they can’t (read: don’t have to) do anything either. There may be someone at Harvard I can talk to, but I doubt it will do any good.

What I should have done was to stop the payments from my bank account as soon as I knew I had new insurance. Then I could cancel the old policy and have the leverage of still having the money. What’s the worst Harvard Pilgrim could do to me? Cancel the policy I was trying to cancel?

Payment plans where the money is deducted from your bank account are a dangerous thing in general. They have the advantage that you don’t risk missing a payment as long as you keep your balance up, but you’re giving away the key to your cash box. You don’t have much recourse once they have the money.

As Arlo Guthrie said, you may know someone who’s in a similar situation, or you may be in a similar situation, now or in the future. Pass this advice along as you see fit. With Obamacare forcing people to deal with insurance companies and taking away the option of high-deductible, low-premium insurance, we can only expect health insurance companies to get more arrogant. (Massachusetts already has forced insurance thanks to Romneycare, so Harvard Pilgrim is ahead of the curve.) Assume they will try to screw you and do whatever you can to prevent it.

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