Here follows a crazy and sad tale...

I transferred my mother to Tufts Medicare Advantage when we moved her from Florida to Mass after my father's passing last year. Last November my 84 year old mami was visiting family out of state, and there she experienced dizzy spells, fell and was taken to the ER. She was there approximately 3 hours and was released after blood test found her anemic. No MRI, no scans, no x-rays. Her care included nothing more costly than a nurse and doctor's physical exams and blood work up.

They paid her co-pay and were assured Tufts would be billed for the rest. Months later, we received a bill from this hospital for a whopping $6,310.12 for her ER visit under the assertion Tufts denied her claim. I was, as you might imagine, pretty darn upset with Tufts. There began a long saga of calling Tufts and the hospital in question to get this resolved.

Tufts blamed the hospital's billing system for mis-coding the claim, and was all sweetness and light assuring me it was not a big deal, and happens all the time and they would "fix it with the hospital do not worry."

Two more months go by and hospital continues to claim they have not received payment. Back and forth I go and then the hospital began sending threatening collection letters to my mother. Now my mother suffers from early on dementia and even before that, comes from a generation where voices of authority intimidate her. I can fully imagine other seniors receiving such threats and caving versus fighting the bureaucracy. I've sadly come to believe this industry preys on seniors and counts on a certain percentage to blindly cave. From friends I talk to when they do take over their parents finances, they've come across such bills paid and share frustrations at their elderly parents so taken advantage of by this broken mess.

Months into this mess, the hospital sent a new "discounted" bill for $2,217.12. I mistakenly thought Tufts had partially paid the claim and this was a remaining balance due. Not so. This was the price they charged non-insured ER patients I was told. A hospital supervisor then unwittingly then admitted this was the actual cost of her visit to the hospital.

Repeat, actual cost for services rendered.

However, the original bill, the $6,310.12, is what they bill insurance companies.

That's $4,093 difference. Nearly double the cost.

I called Tufts expecting them to be upset with this. Two hours later and three transfers to a "higher power" I was told, "well this is why insurance is so expensive in this country." Now I always understood insurance premiums were factoring in an added 10-15% percentage to cover uninsured ER visits, etc. But $4,093 alone for this ONE visit sounded outrageous to me. Silly me I expected Tufts to be outraged, too, but they were very blasé about it all. This is how the system is setup and nothing we can to do to change it was their response.

At this point, disgusted, frustrated and just wanting to RESOLVE this mess for my mami, I said fine, just pay whatever and get this hospital asap off our back. Tufts finally did issue a check. I demanded a copy for our records and sure enough the scan shows $6,310.12.

The health care system isn't just broken, it's gone mad. And, those running this madhouse have become warped into believing this madness is just "normal business as usual."

Will ACA repair this madness? Eventually??? I don't know. No one at Medicare, Tufts or the hospital seemed to have a clue there.

Cluelessness and madness. What a system.