Plain Language - Are we there yet?

I twisted my knee. Before long it is too sore to ignore, so I check with a

physical therapist at the gym. He says he can fix it and that he is a

preferred provider on my insurance; his services will be fully covered.

So I visit him nine times over two months. My knee is better.

But my mind is boggled.

A week after the final scheduled PT session, I get a nine page so-called

“Explanation of Benefits” from my health plan. For each visit, there is

a not-a-bill on which I’m not-billed separately for Exercise Therapy,

Body Movement Therapy, and Muscle or Nerve Trai.

I’m not sure what that third item is, or if I had it, or why the provider

billed $50, the plan allows $33.46, so I owe $33.46. The Note says

“3024”. So I hunt through the pages and find a section labeled NOTES.

Here is Note 3024 (their caps): SEE THE “REHABILITATION SERVICES”

SECTION IN THE ALLOWANCE SCHEDULE OF YOUR CERTIFICATE OF

COVERAGE.”

What?

Looking further, I see on the back of each page that if I disagree

with the payment decision, I can “submit a request for appeal

within 180 days of this notice”. It should be in writing and include

copies of my medical records.

Who has their medical records?

I can’t object to the decision since I can’t determine what the

procedure is. I don’t have a clue what the price should be.

I give up and take the stack of papers to my husband; he’s a lawyer.

After a 15 minutes pouring over the pile, we conclude that this

not-a-bill says the services, including the mystery procedure “Nerve Trai”,

are covered, at least partly, but the insurer is not going to pay;

perhaps because while the individual deductible has been satisfied,

the family deductible has not. But the the employer says there is no

deductible on our plan... It seems the take home message is, “You might

get a bill.” Hardly and EOB. More like a “Not-an- Explanation of No-Benefits.

This story would suggest that, despite the PhD and 30 years in health

services, I have low health literacy. That is, I do not have the capacity

to process and understand information necessary to make appropriate

health decisions. Likewise for my husband the trial lawyer.

I’ve been impatient with the Plain Language crowd, thinking that surely

we all know about readability and jargon and all that by now.

I am wrong. Really wrong.

Keep at it Plain Language advocates!