Column: He’s covered, he makes his payments and his insurer still drags its feet

Most attention on the healthcare front has been focused on Republicans’ single-minded efforts to eviscerate Obamacare. Largely overlooked has been the frustration Americans with employer-based coverage often face in dealing with tight-fisted insurers.

For the roughly 150 million workers and family members covered by employers, healthcare all too frequently is an obstacle course of denied claims, bureaucratic headaches and go-slow tactics intended only, or so it seems, to boost insurers’ bottom line.

Eagle Rock resident Paul Vandeventer is a good case in point. For months he’d been doing battle with Health Net, which covers about 3 million Californians.

The Woodland Hills company dragged its feet in paying hospital bills that accrued after Vandeventer’s son was attacked in New York and required extensive facial-reconstruction surgery.

Vandeventer contacted me after being informed by a doctors’ group at the hospital, New York-Presbyterian/Columbia University Medical Center, that it was done trying to squeeze money out of Health Net. The hospital told him it would instead hold his son responsible for thousands of dollars in outstanding bills.

“These bills aren’t our responsibility if we’re insured,� Vandeventer, 64, told me. “I’m getting screwed around and I don’t like it.�

He’s president and chief executive of a Los Angeles organization called Community Partners, which helps nonprofit groups get off the ground. He and nearly four-dozen staffers, along with family members, have group coverage through Health Net.

“I checked on how how much we pay to Health Net annually,� Vandeventer said. “Last year it was $362,000 in total premiums.�

Not the sort of customer you’d think a major insurer would play games with. Yet that’s what he said was happening.

Vandeventer’s 21-year-old son, Ethan, a Fordham University student, was hit from behind and knocked out in September while walking in the Bronx. It was apparently a robbery attempt, although the young man wasn’t carrying a wallet or any valuables at the time.

After regaining consciousness, Vandeventer said, his son made his way to his apartment and tried to sleep off the attack. By the next day, it was clear he was in bad shape.

He went to Fordham’s emergency medical services office, which took one look at his swollen face and transported him immediately to New York-Presbyterian/Columbia.

The young man required more than three hours of surgery to repair his shattered right cheekbone. The medical care was excellent and a full recovery is expected.

Vandeventer said Health Net had no problem paying about $4,500 for most of the emergency-room procedures. However, the insurer was balking at the $5,000 anesthesiology tab.

Vandeventer called the hospital’s billing department and learned that Health Net first had insisted that the bill contained an incorrect code. A new bill was submitted. Then, he was told, Health Net contended it never received the second bill, even though it was sent by registered mail.

Vandeventer reached out to Health Net for some answers. He said no one could tell him why the anesthesiology bill remained unpaid.

I fared no better. Brad Kieffer, a Health Net spokesman, declined to discuss Vandeventer’s situation with me, even though both Vandeventer and his son had submitted privacy waivers granting him permission to do so.

“I think Health Net is delaying this because that’s just how they do business,� Vandeventer said. “I think their routine is to wear down the medical service provider to the point where they’ll say, ‘OK, we’ll take whatever.’�

John Romley, a healthcare economist at USC, said that even though New York-Presbyterian/Columbia is an out-of-network hospital for Health Net, “emergency care is usually the least contested.�

Like Vandeventer, he speculated that Health Net may have been deliberately tapping the brakes to try to get a lower price from a facility it has few dealings with.

“If they don’t have a lot of business there, they don’t have a lot to lose,� Romley said.

I don’t think any of us would mind if such money-grubbing was confined to the corporate players in the drama. But it’s not. Vandeventer’s son was caught in the crossfire.

If the hospital turned over its bills to a debt collector, the young man could see his credit score get trashed.

This is an example of healthcare consumers doing everything right — they’re insured, they’ve never missed a payment, they’ve helped expedite the billing process — and still being punished because the hospital and insurer can’t agree on who gets the bigger pile of cash.

It’s also an example of a business apparently only doing what’s right after the prospect of a public shaming arose.

The day after I contacted Health Net, Vandeventer received a call from a senior dispute-resolution official at the insurance company informing him that the anesthesiology bill would be paid immediately.

A spokeswoman for the Columbia doctors’ group subsequently confirmed to me that a payment was in the works.

Again, this isn’t a story about problems with Obamacare. This is America’s primary form of health insurance — employer-based group coverage — coming up short for customers in good standing.

And this isn’t just about the Vandeventers. I’ll bet many people reading these words have had some beef with a health insurer at some point, despite dutifully paying all premiums and deductibles.

As Vandeventer told me, patients should never have to fight for fair treatment “when that should be the presumption.� And he asked: “What about the family less knowledgeable and for whom navigating a corporate bureaucracy is unfamiliar or intimidating?�

Sadly, that’s what our profit-hungry healthcare system is counting on.

David Lazarus’ column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to [email protected].

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