Insurance Insanity

I have been fortunate that I’ve always had sufficient and even good medical insurance nearly all of my adult life. I do admit part of it is fortune, but part of it is also because of the choices I’ve made, including working for over six years at job I hated, for a company I hated and with people I truly despised. Yet, I kept that job for the paycheck and insurance coverage.

To be completely honest though, I really didn’t need either, as again through a combination of good fortune and personal choices, my paycheck has not been a requirement  to maintain our household for many years. My husband has a good job, one that he has worked very hard at for more than twenty years that comes with both medical benefits and a paycheck sufficient to support us. We are far from rich, but we have a comfortable life, primarily because we live well within our means. Our choices have included foregoing all but two family vacations in the past eleven years.

The real reason for being homebodies though has been what other families would spend on leisure activities and vacations, we have spent
on medical bills. In this department we have not been quite so fortunate. In nine of the past eleven years we have far exceeded our out of pocket individual contribution under our medical plan, thanks to me.

That means I have become an expert layman on a variety of medical issues, at least those that pertain to my health. I’ve learned everything there is to know about anaphylactic reactions to certain food additives and some of the long term effects on various body systems. I’ve had
more than a dozen hospitalizations and more than twice that number of trips to the emergency room and urgent care facilities. I’ve seen specialists of just about every stripe, and have been a guinea pig for more than a few drug therapies. All this for someone who made it into her mid-twenties without a single cavity, and into her mid-thirties before her first overnight stay in a hospital. I had never even broken a bone until I snapped a metatarsil in my foot by falling off the edge of a sidewalk, something I've now done three times. Yes, the same sidewalk, in the same spot, in front of my own house. In short, I’ve learned a lot about how badly broken the health care system is in this country and the true cost of medical care, insurance, doctors and hospitals.

I am now the person who will consent to go to a doctor only when absolutely necessary. I'm not afraid of doctors and hospitals, it's just that I've spent more than my share of time and money on them. If I'm conscious, I won't be going to an emergency room ever again. I will literally have to be bleeding out, have a bone protruding through my skin or lacking a heartbeat to go voluntarily, though if I didn't have a heartbeat, it wouldn't be my decision to make. This attitude of mine really doesn't make sense, something my husband has repeatedly pointed out, as every time I have gone to a doctor or hospital, there has been something very wrong and in need of immediate and often drastic medical intervention.

One would think that because of this history, I would be all for ObamaCare. In theory I am, in the sense that I know the system to be broken, I just don’t think this is the fix. On one hand, I would be happy to never again have to deal with the insanity, bureaucracy and stupidity of insurance companies. On the other hand, I fear how much worse it would all be if  controlled by the Federal government, that bastion of common sense and efficiency.

I’d like to share a couple stories on how one of the nation’s oldest, largest and most universally accepted insurers frivolously spends our premiums and contributions. I challenge anyone to tell me how any of the following would be different, much less better under an even larger bureaucracy.

My doctor had ordered a test as a last ditch effort to diagnose my digestive tract aliments. Every other possible test has been done, and even the Mayo clinic concurs. I’ve changed my diet and exercise regimen, tried a host of prescription, over the counter and natural remedies, all to no avail. This final test may not answer all the questions, but the only other option is exploratory surgery, something that is not actually an option since I seem to have a problem with excessive internal scar tissue. I’ve had four major abdominal surgeries, two done on emergency room admissions and literally a matter of life and death, so the scar tissue problem has been noted first hand by surgeons. I joke that I am hollow and don’t have any more spare parts.

The insurance company doesn’t like this test my doctor has ordered, as it is expensive. Preauthorization must be procured, even though
our plan is a PPO which does not require a referral for specialists and most tests.

The doctor’s office sent in all the required paperwork, notes and previous test results as justification for this test.  It then took the insurance company nearly two months to issue an approval and preauthorization consent letter. In the meantime, I got to sit around and deal with the issues that sent me to the doctor’s office in the first place.

While the insurance underwriters were hard at work protecting the bottom line from a potentially  - in their eyes – unnecessary and costly
expenditure, I received in the mail a four color printed brochure from this same insurance carrier about a drug the doctor prescribed. As it happens, it was a drug that I was on for thirty days only and as it did not do as was hoped, was stopped by my doctor. The brochure gave all the same information as the leaflet I was handed by the pharmacist, which was itself a repeat of the information I received from my doctor when she prescribed the drug. The capper is that I received this piece of mail nearly two months after I stopped taking the drug, which means it was more than three months since the insurance was billed for the one and only prescription I had filled.

While still awaiting the underwriters’ decision on the requested preauthorization for the test my doctor ordered, I received a call from the insurance company. As I was not home when the call came in and the message on the answering machine was vague, something about important information for me specifically, I quickly called the phone number as directed.

I was quite surprised to hear myself addressed by name by the recorded voice on the other end. My first thought was this was a pretty
sophisticated system that registered the incoming call as being from me. My second thought was this was a pretty expensive system that used this technology. Still, since I had been waiting for this preauthorization, I was glad to have even this quasi-personalized contact from this faceless bureaucracy. At least at first.

This message, which required voice interaction on my part by primarily answering yes or no to questions posed was not about the long awaited preauthorization, nor even the medical condition for which I am currently being treated. It was my insurance company telling me via a recorded voice that a woman of my age needed to have an annual PAP test, and through a series of prompts, telling me exactly why and how important this screening is for me. I say ‘for me’, as the voice addressed me by name, knew my age and had left me a voicemail with this specific phone number to call.

Sounds nice and warm and fuzzy, doesn’t it? A big, nameless, faceless bureaucracy really isn’t, and here was the proof as they were helping
me be proactive about my health. Except this particular procedure doesn’t apply to me, and certainly isn’t something I need to have done as an annual screening. I would think the insurance company would know this, as the claim for the radical hysterectomy I had a decade ago was paid by this same carrier, under the same policy. I simply lack the parts this procedure would test.

It is always nice to be reminded of having gone through the nightmare of being dropped suddenly into early menopause. Better still is being
reminded that I became unable to have more children at least a full decade before I was ready to make that decision. The added bonus of seeing how wisely and zealously guarded expenditures are by my insurance carrier just made my day.

Of course, the computer voice did not give me the option of speaking with a living person so I could check on the status of the preauthorization my doctor had requested nearly two months previously. I guess all the real live people were busy thinking up new ways to spend my premiums and copays, I mean guarding their ever so thin profit margin from frivolous expenditures on unnecessary tests.

Comments

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  • " In nine of the past eleven years we have far exceeded our out of pocket individual contribution under our medical plan, thanks to me."

    enough to meet the tax deduction requirement?

    "something I've now done three times. Yes, the same sidewalk, in the same spot, in front of my own house."

    you've fallen off the sidewalk three times, or broken your metatarsil three times, or both?

    "the Federal government, that bastion of common sense and efficiency."

    could not have said it better myself.

  • I'll answer, but not in order. Yes, but sadly not every time; thank you and both, which is something I assure you I don't brag about. The first time it was dark. The second time I was walking fast, suddenly stopped to turn around, and well, things didn't go so good after that. The third time, I still don't know how it happened, but it did involve my face ending up in the grass. As did the one of the previous times. I don't want to talk about the other time. Nor do I discuss how many years of ballet were wasted on me.

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    Denise Williams

    Born and bred in Chicago, now living in the wilds of far suburbia. I'm a Gold Star Mom, a wife and step-mom to two terrific boys. My views are generally politically and socially conservative, though I am far from a Party line Republican. I believe in this country, our Constitution and above all, in the right of life, liberty and the pursuit of happiness. I believe our government is supposed to serve the people, not tell them how to live. To me, this is just common sense, but since it seems to be a minority opinion, it has become "Uncommon Sense".

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