Tikkabik

So it's open enrollment time at my employer's again -- the annual opportunity we have to review the different medical plans offered by the company I work for to see who offers the best plan, and make changes accordingly.

We're not a terrifically healthy family, so this is actually quite important two us. Of the five of us, three of us are taking medications to deal with various mood and brain disorders; three of us are involved with ongoing immunotherapy to resolve long-standing allergy issues; I'm dealing with diabetes and Bonnie is dealing with ongoing internal medicine issues related to her child bearing, which ended five years ago. Even James, our youngest, racked up massive bills last year when he managed to break his forearm in two places and create a second elbow for himself temporarily.

Right now we're enrolled with CIGNA, a Preferred Provider Organization, or PPO. We actually quite like CIGNA, because they have a pretty broad basis of providers, and as a PPO they don't require us to go through the rigors of pre-authorization for about anything except for surgery. Our doctors' offices seem to like them well enough too. What's more, because they're a privately funded PPO, they have more flexibility than other health plans do in their allotment for mental health provider visits, and this is huge with us.

Our alternative is one of several Health Maintenance Organizations, or HMOs, that my company offers plans with. All of them have shortcomings that just don't fit well with us: One's network of providers in our area is too small, another is a lot more expensive than what we currently have, and we've been warned away from another by enough patients and doctors that we will heed their advice.

While CIGNA is decent to deal with, there's one fundamental problem with PPOs: Paperwork. Every single thing that we do that's covered generated paperwork with them that we end up getting copies of. And paperwork can get fouled up very easily through every step of the process. Sometimes it's with the doctor's office using incorrect billing codes. Sometimes it's with the doctor's billing service using incorrect provider information, and having their claims rejected. Sometimes it's with CIGNA sending the wrong check or the wrong amount.

It's an imperfect system, but at the end of the day, it's one of the better health insurance plans we've had.

But today Bonnie spent the better part of three hours getting issues resolved with bills we've received and making sure our coverage through one provider is all set, because he's not normally part of our plan. This involved extensively haggling on Bonnie's part with service reps at CIGNA and billing services to get them to resubmit claims or reprocess claims. This also involved talking with several doctor's offices and a hospital, and a lot of requisite buck-passing between clerks and low-level staffers who'd rather just give you a different phone number than listen to your question.

It's at times like this that I've wanted a socialized health care system like the one my friends in Canada enjoy.

Until I talked to one friend who's going to wait a year for a specialist he needs to see, because demand in his area far outstrips supply. Sure, he could pay for a private practice, but that rather defeats the point of national health care, don't you think?

Anyway, the bottom line is, there's something very wrong with the system here, and I doubt slathering another layer of government bureaucracy and inefficiency is going to fix it.