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Frank Madden has no trouble with numbers; he's a financial broker, at home with subtotals, percentages, columns of figures. But his medical bills were beyond his grasp. 'The paperwork was, like, ridiculous,' says Madden, who has chronic health problems related to diabetes. 'My wife and I would have it spread across the dining room table. It was either get a divorce or hire Mary."
That would be Mary Rzeszut, an expert in "claims assistance," one of several sad subprofessions spawned by the squabbling over managed-care bills. Her business is built on patients' distaste for the administrative aftermath that can follow a visit to the doctor. About half of Rzeszut's clients hire her to battle over specific unpaid claims. But the other half (including Frank, who, still happily married, is now one of her clients) pay her $35 an hour to handle all health- insurance-related drudgery. "They just don't want to deal with it," observes Rzeszut.
Few people do want to face their own bills, let alone anyone else's. But Rzeszut has a head for the annoyance-studded field of accounting disputes, as she discovered when she got her parents' insurance company to fork over $6000 for a claim it had initially denied. "I'm organized," says Rzeszut, whose Mineola office is adorned with neat stacks of xeroxed checks. She is also patient, which allows this mother of two young children to maintain her equanimity through the months of back and forth that most of her cases require.
There is something absurd about the idea of Rzeszut a mild-mannered woman who works out of her home with her toy fox terrier in her lap making mammoth companies behave. Indeed, Rzeszut says the State Department of Insurance and the State Attorney General's office regularly fail to follow up on her requests. And so far, in her five years in the field, the biggest sum her persistence has yielded is only $6000.
But, like the stand-ins who get paid to wait in line at the DMV, Rzeszut and her ilk spare people headaches and indignities. "People are intimidated," says Rzeszut. "They don't know what to do except make a phone call or two."
American Medical Consumers, a California-based, for-profit company, is also trying to tap into this beleaguered-patient market. AMC president Vincent Riccardi, a doctor with an M.B.A., offers his credentials to enable mere lay people to get in touch with medical big shots who would otherwise ignore them. "I had a patient who called her HMO and they wouldn't even tell her who the medical director was," he says. "But if I call, I say I'm Dr. Riccardi, I want to speak to the medical director, then I get through." Riccardi's charges start at $90.
Riccardi has gone even farther in mining dissatisfaction for opportunity. AMC sells medical diaries in which embattled patients and perhaps the stray hypochondriac can document their symptoms and interactions with doctors in preparation for possible altercations down the road. On his Web site, www.medconsumer.com, Riccardi offers a Personal Medical Record System ($34.95), which includes a binder, a month's worth of shrink-wrapped, triplicate forms and telephone coaching on how to use them, a "personal medical organizer" ($21.95), and other products designed for people who expect not to be believed. The idea, says Riccardi who also works as a consultant to HMOs is that more documentation means fewer denials. He even suggests that patients retain his services before they run into problems. "That way we can make sure people won't be frustrated and have extra out-of-pocket expenses" and the good doctor can make a few extra bucks.
Robert Finney's post-managed-care enterprise is also rooted in the notion of patient-as-underdog. But Finney, a former exec-turned-patient-advocate, takes on the system from a decidedly outside, wacky perspective. His book, How To Play HMO Hardball ($19.95), includes its own patient-protection forms, which Finney refers to as "the antidote to the HMO poison pen." Finney and his wife have also written a number of songs, such as "The HMO Blues" and "Plain Folks Health Care" (to the tune of "Georgia on My Mind") that express his strong feelings about managed care. Finney's Web site, www.hmohardball.com, veers from personal stories about his wife's medical troubles into the paranoid, with statements such as "the HMO secret police force is watching."
Others don't share his anti-managed-care obsession. Riccardi, for instance, says he's not opposed to managed care, just "opposed to the discrediting of the consumer." And Rzeszut seems no more ruffled by HMOs than by the old-style health insurers she also works with occasionally. But, whatever their feelings about managed care, the system is providing them and others with new and strange careers.
"Managed is more of a paperwork nightmare," explains Susan Dressler, president of the Alliance of Claims Assistance Professionals, an organization that now has 85 members. As for the future, "There's going to be more problems and more paperwork," says Dressler. "And that means more work for us."