IN THIS EPISODE
HMOs may seem like a good deal, but what if you need a medical specialist? Will the doctor you need be in your network? And what about those crazy bills? Join host Brenda Gazzar and guest Nilton Fonseca, husband, father of three, and a construction engineering director, as he describes his struggle to find a plastic surgeon experienced in his condition. Did his appeal to the relevant state regulatory agency help? (Take a guess.) In this second of two podcasts, Fonseca details more hassles with his health insurance that marred his treatment experience as he battled breast cancer. How could his experience have been different with single payer?
SHOW NOTES
WE DISCUSS
How easy was it to find in-network doctors experienced with your condition?
“..it’s difficult to find, or has been difficult to find…surgeons with current competency in working on males – specifically reconstruction of breast cancers…” – Nilton Fonseca
What did you try next?
“I tried to then go out of network. I requested referrals and that was repeatedly denied by the insurer…it just fell on deaf ears and it got to a point where I ultimately applied for an appeal. I made an appeal to the Department of Managed Health Care in Sacramento…they came back to me denying my appeal” – Nilton Fonseca
How’s the billing process been?
“…when I see some of these bills that sometimes come from the insurer, you know, I’ll get a statement at the end of the month that said, okay, you had a procedure and your procedure maybe cost like $25,000 or $30,000. But actually this is what you’ve saved and this is what the physician is getting paid, which is maybe $7,000 or $8,000. So then I asked a question, why did you charge $25,000 to start with…” – Nilton Fonseca
Helpful Links
HMO Plans: What Are They and How Do They Work?, Value Penguin
Many Cancer Patients Face Mounting Bills Despite Having Insurance, U.S. News & World Report
Confusing and high bills for cancer patients add to anxiety and suffering, The Conversation
Up to 80% of Hospital Bills Have Errors. Are You Being Overcharged? Healthline
5 Tricks Hospitals Use to Overcharge (and What You Can Do About It), Claim Medic
Episode Transcript
Read the full episode transcript.
Guest Biography
Nilton Fonseca, a husband, and father of three, is a professional with over three decades of construction project experience domestically and internationally. He holds a degree in engineering and loves reading, traveling to new places and spending time with family and friends. He currently resides in the South Bay of the Los Angeles metropolitan area.
Get Involved / Take Action
Subscribe to HEAL California for health policy news with a California focus
Join Healthy California Now – a coalition working toward a California single-payer system. Individual and organizational membership available.
Join Health Care for All California to keep up with local actions to support California single-payer health care.
Join Physicians for a National Health Program (PNHP) to support the national campaign to improve and expand Medicare to all residents of the U.S.
Find more Code WACK! episodes on ProgressiveVoices.com, on the PV App and on NurseTalk Media. You can also subscribe to Code WACK! wherever you find your podcasts. This podcast is powered by HEAL California, uplifting the voices of those fighting for health care reform around the country. I’m Brenda Gazzar.
_________________________________________________________________________________
HEAL California is an independent news and information hub focused on the Medicare for All movement.
With non-partisan news, views, podcasts and videos, we highlight the on-going injustices of our broken healthcare system and amplify the voices of those who are most impacted by it.
Our Podcasts shine a light on the failures of America’s healthcare system, while explaining how Medicare for All could help.
Our Media page offers connections to experts and additional resources including links to legislation and studies.
Keep up with the Medicare for All movement!
Follow us on Facebook, Twitter, and Instagram. Subscribe for email updates.