A few weeks ago you'll recall me crowing about my cholesterol. Well, I have just received a bill for that routine visit to my Primary Care physician at Boston Medical Center. For $662.

While I'm loath to admit it, because of the contingencies of life as a freelancer, I have had no medical insurance for most of my adult life. In the past I have paid out-of-pocket for medical, dental, and eye care. (For the record, I pay my share of taxes like everybody else, too.)

But a couple of years ago a minor incident sent me to BMC's urgent care clinic, where I was signed up for Free Care. I was assigned a Primary Care physician whom I liked very much, and went back once or twice yearly for check-ups at her behest. I utilized Free Care for these routine visits.  I was never billed. 

I ended up with a plastic card with the words "BMC CareNet" on it, which I was asked for whenever I visited my physician, though I don't think I ever really knew what CareNet was, and still don't. I don't know if anyone really does.  But they always asked me for the card, and it seemed to do the trick, so I never bothered much about the details.

When I went in for my cholesterol check, I was told my Free Care had lapsed. I had gone through the unpleasant process of enrolling a couple of years earlier, but don't recall being informed at the time or notified subsequently about the need to re-enroll at some point.

I was handed something to sign in the waiting room and told I had a limited time to enroll in Commonwealth Care, which I did rather painlessly by phone shortly after that roughly 15-minute $662 visit to my doctor.

A couple weeks later I received a small pamphlet with no specifics but a lot of pictures of very good-looking multicultural faces smiling and laughing, and so, so happy to finally have healthcare coverage. Along with a bill for $18, which was to be my monthly premium payment. (I would also be liable for copays, I was told.)

I was all set, or so I thought.

And then late last week I get this bill for $662 for a cholesterol check.

It just seems a little steep, is all.

If the cost of the visit to my physician (who was a perfectly charming medical resident, by the way) were even somewhat reasonable, as I believe the services of my dentist, Geoffrey Davis, to be, I would gladly pay out-of-pocket and have done with it. But my dear Dr. Davis quotes me a price before he sets to business, and we agree on treatment and a payment plan together from there.

BMC provides no details beforehand, and I did not receive an itemized bill for "services rendered." I got a form letter saying "The balance is your responsibility...remit in 7 days." It sounded an awful lot like something from a collection agency, although it's the first I'd heard from BMC.

Now's where the real fun begins. Yesterday morning I started off the day with a call to Commonwealth Care. I was lucky to get a live operator pretty quickly, and one who was fairly helpful. She informed me that because of new legislation which had expanded full coverage to those 150% above poverty, my status had changed and I was eligible for full coverage with no monthly premium.

(I want to stress that I very rarely use medical services, am not on any meds—although some would like to see me permanently sedated, I know—and still pay out-of-pocket for dental and eye care.)

So, anyway, that was good news. But I would have to re-enroll, she said. Well, all I wanted to know was if that $662 bill would be covered or if I had fallen through the cracks. And if it was covered I needed a policy number, since I had still yet to receive a card from Commonwealth Care. Unfortunately at about that time, I was called away to teach, and couldn't finish the re-enrollment process.

I tried back later in the day, and spent a good twenty to twenty-five minutes on the phone, waiting for a live operator who never materialized.

I also tried calling BMC, and after similar waits, finally got to talk to a very nice lady, who took down my "old" pre-re-enrollment Commonwealth Care policy number (which was on my $18 premium payment stub).  But the conversation was not heartening. She seemed to know less about the policies than I did, and she hesitated to assure me that the cost of the visit would be covered retroactively by Commonwealth Care.

This morning I didn't have class, and decided to wait as long as I had to to get a live operator at Commonwealth Care, to be sure to get re-enrolled, and to ask about this bill.

When I finally got an operator, he sounded like a sixteen year-old kid from Roxbury on work-release from Juvi. The perfect tense did not exist for him, and he had no demonstrable knowledge of the third person singular, either. My first operator at Commonwealth Care was very kind, obviously Latina, with accented but perfectly functional English. I felt like there was more of a language barrier this time around, and the last thing you want with this kind of call is a language barrier.

So I didn't trust him right off the bat. I'm sorry, but people who can't speak English as a first language better than people who speak it as their second do not get my trust, I don't care if they're white, black, or purple with neon green spots all over. I don't particularly like male operators, either, a prejudice I am hard-pressed to defend, but there it is. And to cap it off, I think youths—and this kid could not have been over twenty—should be seen and not heard, which should rule them out of the running for call-center jobs.

When he told me I didn't have to re-enroll I was suspicious, to say the least. I can see showing up in the ER with my amputated hand or something and being told it's a shame I hadn't re-enrolled, but it's too late now.

I said I had been told by someone older and more official-sounding yesterday that I had to re-enroll, and I wanted to re-enroll.

He put me on hold, came back five minutes later (probably after a bathroom break) and said I was all set. I had tried to explain to him in simplified English (what a mentor of mine once called "Tarzan English") the problem with my bill, but he wasn't having it.

"You all set," he said. "You not gonna pay no premium. You all set."

OK, great. I saved eighteen bucks a month! Now, about that $662—

"You all set. Thank you for calling Commonwealth Care and have a great day."

Bugger it.

Next I called BMC back. Got the run-around. Was told to call Free Care. They didn't have the number.

I went online and found a number, and got what sounded like an antiquated answering machine telling me to leave a message at the beep and they would call me back. Mm-hm. That's what they all say.

So, is this the most advanced post-industrial service economy in the world, or what?