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'You are covered until you are sick': A moment in the Orwellian world of health insurance

Casey Jarrin wanted to know how much her ultrasound would cost. HealthPartners couldn't give her a straight answer.

Casey Jarrin wanted to know how much her ultrasound would cost. HealthPartners couldn't give her a straight answer. Unsplash.com

For the past 12 years, Casey Jarrin of St. Paul has been insured by HealthPartners. It was her plan when she was a faculty member at Macalester College, and it’s her plan now that she works freelance, leading education workshops.

For the most part, it’s been going well. But a couple of years back, she had a complicated, protracted miscarriage, and in some ways, she’s still dealing with the fallout. About two weeks ago, she visited her doctor with prolonged, severe abdominal pain. An ultrasound was ordered to ensure she wasn’t in danger.

Jarrin had the proceedure the next day, but she was a little worried – not about her health, per se, but about what it would cost her. Earlier this year, she also went through physical therapy. Even though she’s on HealthPartners’ “Individual Peak” plan, which boasts a 20 percent coinsurance fee after the deductible, she ended up having to pay for nearly everything out of pocket.

This time, “I didn’t want to be surprised,” she says. So, after the ultrasound, she called up HealthPartners to ask how much she’d be paying.

After being “bounced around” to different departments and employees, Jarrin says, she was no closer to getting answers. And she was still in the dark last week, when a customer service rep called to ask if she was satisfied with the company’s response to her questions.

“I actually haven’t gotten any information yet from you,” she said.

She wanted to know what the ultrasound would cost before she got the bill, and why some of her necessary medical procedures ended up costing her so much.

The rep allegedly told her they couldn’t reveal how much it would cost, since additional procedures might change the price. Even HealthPartners cost-of-care line, which is just for questions like these, could only provide “their best guess.”

According to Jarrin, the rep told her that “Insurance is for preventative care, not for when you get sick.”

It turns out that on Jarrin’s plan -- and most HealthPartners’ plans, by the company’s own admission -- only preventative procedures and routine checkups get full coverage. The ultrasound would be applied to her $1,000 deductible first. And the reason some of Jarrin’s procedures cost so much, the rep allegedly said, was because her insurance could only “negotiate a contracted rate” with her “provider.”

But this didn't didn't make any sense. 

“I go to HealthPartners clinics and providers for my medical care, so my provider is the same company as my insurance,” she says. “This means HealthPartners is negotiating rates with itself, which seems borderline illegal.”

HealthPartners spokesperson Becca Johnson says the company can’t discuss the specifics of Jarrin’s case, but confirms that the company does “negotiate rates with providers,” including its “own care system.” The company provides a few “tools” for customers to “view estimates” for the cost, but estimates only.

As for the rep who said that insurance is mostly for the healthy:

“We strongly believe health insurance is beneficial for when you are well and when you are sick,” Johnson says. But no – medically necessary tests may not be considered “preventative,” and therefore may not be covered “100 percent.”

Jarrin eventually got her bill. The total was $675. After HealthPartners “negotiated with her provider,” she was left on the hook for $432.

It wasn't a nightmare “$500,000 hospital bill,” she says, but still not great. And things got even weirder on Monday, when she had a follow-up appointment with her doctor, who asked about how much she’d paid.

“She was shocked,” Jarrin says, “And communicated that she was extremely surprised that I would be responsible for a procedure that she ordered for ‘acute pain’ that was ‘definitely medically necessary’ and ‘absolutely not an elective procedure.’”

If this has taught her anything, it’s that even if you’re doing your best to understand how insurance works, clear answers are just out of reach. Even doctors, she’s learning, are struggling to navigate a system to make sure patients aren’t overcharged.

Says Jarrin: “You are covered until you are sick.”