I have it relatively easy. But managing healthcare finances for a family is a terrible, time-consuming experience and should be one (of many!) drivers for single payer healthcare.
I am very, very fortunate: I have good insurance through my employer, and an FSA too. The FSA is a huge boon for my family's regular medical expenses. But there is no communication between the FSA, my insurance company, and our medical providers. Thus, this is one of the things I need to manually manage every year. It's not insignificant, either, but a lot of it is due to shitty, old technology and processes that haven't been examined by these companies in forever.
Let me give you an example.
Say I take the kiddo to the hospital for a doctor's appointment. I pay with my FSA a co-pay of $40 or thereabouts. The FSA card usually works, but sometimes it'll just be rejected for no good reason. Let's assume for this example it works.
About a month later, I get the bill from the hospital for any lab tests, blood work, etc. It's a big bill, usually multiple times the cost of my co-pay. So I go online to pay the bill (which is a horrible experience). I pay the bill. About a week later, I get an email notification from my FSA company – always comes at 2am – telling me that they need “more information” to process my claim. So, it's pending.
Now what I need to provide that information, which is either a receipt from the transaction (which, sometimes, I keep) or the EOB from my insurance company. Since my insurance company has a shitty-but-it-works portal, I can usually access all my EOBs as PDFs, but not always because technology is hard:
This is a polite way to write “¯\_(ツ)_/¯”.
So, I opt for that because receipt management is also a pain in the rear.
I log on to my FSA's portal – it's always a portal – and am subjected to another shitty experience. There are ads, by the way. I navigate to the pending claims tab which shows me all pending claims for the past three years, and I can't resort them. So I start at the bottom and work my way up. For each line I get a modicum of details: where I paid (which isn't always accurate), the amount, the “service date” (which is when they processed the transaction, not the actual date when I was at the hospital), the amount, and a cutesy upload-to-cloud icon for my proof.
I open up a tab and log on to my insurance company's portal. I get a pop-up asking me if I want to convert all my EOBs to digital, which I did three years ago, and I can't tell this popup to go away forever. I click close. I go to the Claims Center tab, which is a table view of all the claims with amounts, service dates, and so on. I change it to view all, because viewing 10 at a time is silly.
I then hop over to the FSA tab, and look at the amount. I note the source too. I then do an in-page search on the insurance side for the exact amount I paid. Let's say it does line up, which only happens about 50% of the time at best. I then click through to the detail page. A printout of the detail page, by the way, isn't sufficient for the FSA company – they require the EOB. I click the EOB link; sometimes I get the error above, sometimes it works and shows a PDF. I then need to tell Safari to download that PDF.
I then hop over to the FSA site and click “upload file” for proof. Now, the tricky part: if the file size is too small (and there are no thresholds mentioned anywhere), this just won't work. It'll come back to the page and give up, with no errors or anything. I just have to know that the file is too small. But if it works, it shows a new cutesy file icon, and I'm done.
Unless.
Sometimes, the FSA company finds fault with the information I provided. It's usually the amount: hospital bills come in clumps, sometimes (unsure why), so the amounts may be a portion of what I paid or they may be all or it or all plus some more from other visits. Whoever handles this at the FSA company doesn't care, and they'll reject it again. So I'll get another email telling me it was rejected, usually about 3-4 days later. But there's not a rationale given in the email, so I have to go back and do all that again and hope I am getting the right information to them.
Whew.
I need to do all of these steps for all of my claims for the FSA and, thanks to the system that is hospital billing (something I know more than a smidge about thanks to all the work I've done in healthcare), it happens frequently. I'd say that if this all goes smoothly, uploading proof to the FSA company takes me about, ah, 5 minutes. But when it doesn't, it can take hours simply because there is no one source of truth here. No one believes anyone, and no one takes my word, even though I know what happened.
This is a mental and psychological drain, and also takes not-insignificant time. If I don't do this, the FSA company assumes my purchases are ineligible (I guess I'm buying pants with my FSA card?!) and I owe them the money back at the end of the year. The only upshot to all of this is that I have the calendar year to provide this proof. I started doing this monthly but it was taking so much time that I started just clumping it all together towards the end of the year instead.
Oh, and the FSA amount is limited by the federal government and doesn't last but a few months for my family at most. The rest of the year, it's all out of pocket. Which, I guess, makes it a wee bit easier; I don't need to upload a PDF to myself.
All of this is a ridiculous, stupid system that penalizes people for doing what they need to do to be healthy and get care. And this is with good insurance, good benefits, good doctors and all the privilege that goes along with that.
So yeah. The system is broken. Obamacare made it significantly better but it still has a ways to go. The AHCA would make it much much worse. Single payer is the best way forward, and the longer we wait on that, the worse we'll all be.
