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Oh joy! Went to get my COVID vax update this morning (timing makes sense for me: students pouring back with cases at peak, yuck), and…

…the pharmacist tells me HealthPartners insurance is refusing the updated vaccine.

SPOILER: The end of this thread is that I got the shot, but private health insurance should be burned to the ground.

1/

Called HealthPartners. Time to human: ~10 min. To their credit, the human was super nice. Turns out HealthPartners did some massive internal corporate faceplant, and the vaccine wasn’t entered into their computer systems properly. It’s wrongly refusing across the board.

Problem will be fixed “by Saturday.” My appointment is now.

2/

They have a solution:

- Pay for the shot out of pocket now (which is $200).
- Save the receipt.
- Bring the receipt back to the pharmacy after Saturday (physically, this can’t happen over the phone, not that CVS is reachable over the phone anyway), and ask them to refund and rebill, and then it should go through.
- If that doesn’t work, upload receipt to HealthPartners and ask for reimbursement by going to their web site > Log in > My plan > Overview > Find a Form❮post truncated for length❯

3/

Consider:

- I can afford to pop $200 out of pocket and get reimbursed later. Not everyone can.
- I can afford 15 minutes wasted on the phone. Not everyone can.
- I can get back to the pharmacy easily for the billing retry. Not everyone can.
- I’m sufficiently fluent, pushy, and culturally privileged to navigate this whole stupid situation. Not everyone is.

Each of those “not everyone”s is somebody who doesn’t get vaccinated — at who knows what cost to themselves and to us all.

4/

THE BIG QUESTION: What purpose does this serve?

It wasted a lot of people’s time: mine, the pharmacist’s, the support person at HealthPartner’s, presumably a bunch of people deep inside the pipeline of this whole stupid machine.

Did it improve care? No. Did it improve outcomes? No. Did help allocate some resource more efficiently or more effectively? No.

Did it even improve net •profit• across the whole health system? No!

5/

What purpose does this serve?

Well, we’ve set up a hideous Nash Equilibrium where health providers, insurers, pharma corps, and governments all stand to save money by relentlessly trying to gouge one of the others into paying for everything.

We are simultaneously trying to (1) sort of externalize the cost of health care (lest the market price individual human lives (not that it doesn’t, but we try)) while (2) using the market to make things efficient…somehow. Outcome: nonsense.

6/

Paul Cantrell

I don’t love the idea of nationalizing all health care — I think it’s good to have many •strictly nonprofit• hospitals, docs, etc with some degree of autonomy — but I am ready to see private insurance eliminated completely. I don’t see that it adds any value whatsoever.

7/

TL;DR:

- Paul is grumpity.

- US folks, if your insurance hasn’t caught up with the updated COVID shot, pay out of pocket if you can and fight for a reimbursement. And maybe write to your electeds (I am).

/end

@inthehands OMG, I am going through the same with St. Luke's Health in Boise right now, which hasn't entered the vaccine in their system. I was on hold forever yesterday, then waited hours for call backs. The last one said "We've elevated this to our software department." Only one of 100 problems I've had with them. I think I will just pay for the shot and send them reimbursement request (I'm leaving on a trip in 10 days).

@IdahoLark
This seems about on par with what one would expect from them.
@inthehands

@inthehands @daniel How are you getting 2 boosters a year? Are you paying cash for one of them?

@inthehands @daniel Sorry, I don't quite understand your answer.

@fuzzychef @daniel
Sorry! Yes getting two boosters a year, no not paying out of pocket. (Insurer never seems to object.)

@dnelson
My understanding from people who actually understand the horrid interior of these systems is that actual Medicare as it exists has all sorts of logistical barriers that make it so it can’t just scale up to national scale without a lot of re-plumbing. But if you’re speaking vaguely, in principle, then yes.

@inthehands I guess I was thinking of Medicare as a system of insurance dealing with the provider system that exists (government as payer, but not provider), with fairly stringent cost controls, now including (some) negotiated drug prices. I am not familiar enough with the intricacies under the hood to speak to the potential problems in any attempt to establish a “Medicare for all” system, so for now I accept your appraisal in that regard.

@inthehands

"I am ready to see private insurance eliminated completely. I don’t see that it adds any value whatsoever."

YES!!! 👍

@IAmDannyBoling
[nods] I mean, people who share our view on this are I think far too careless about how easy or obvious the process would be. Pulling the knife out of the wound is dangerous, tricky business. But it is a knife, and it is a wound.

@inthehands

In my entire life, I've never understood why the US puts up with private health insurance. How is putting a middleman ever going to save us money? (A: They're not because they're not designed to save us money. They're to save corporations money.)

And then to tie that with your job makes even less sense!

I hope I live long enough to watch private primary health insurance wither and die.

(If they want to hang around as bonus, secondary health insurance, that's their derogatory.)