Monday, February 5, 2007

Your Insurance Sucks

A mother was in the office the other day, and her child was covered by a certain for-profit, commercial insurance...not to name names, but the company rhymes with "You lie, Ted."

Last year her co-pay on office visits was $20. As of Jan. 1 it rose to $40. She was not happy about this.

I wouldn't be pleased either. And I will go out on a limb and guess that her premium did not decrease. So this health insurance company gets the family to pay $20 more per office visit, and they get to pay $20 less.

That is an awesome way to make a profit: shift the cost to someone else!

Too bad I can't figure out a way to do that (legally, that is).

This same insurance company (whose letters can also be rearranged to form the phrase, "DIE, NUT") announced last year that it would finally start paying for both a sick visit and a check-up on the same day. Previously, it would only pay one or the other. Now most check-ups are pretty straightforward, and minor issues are expected: the baby has some cradle cap, my teenager has a little sniffle today. But every once in a while they present with something more complicated: a wheezing infant, a preschooler with bad behavior problems. If the insurance company won't cover both on the same day, I tell the parent: we can address the problem or do the check-up, but not both. (Expecting a doctor to do otherwise is like taking in your car for a tune-up, finding that your brakes are shot, and expecting the mechanic to fix the brakes for free, since "it's all part of the tune-up.")

Well, this nameless insurance company now says that due to computer issues, it won't start paying for both a check-up and sick visit on the same day until, oh, December 2007.

(Warning: sarcasm ahead.)

Dang, that must be a wicked bad computer problem. They must be getting some serious l33t hacker dudez to crack that code. Maybe they're asking both Steve Jobs and Bill Gates to work together on this one. I mean, how in the world would you program a change in a reimbursement rule? They must be outsourcing that one to, heck, every computer programmer in Bangalore and Boston combined. I hope they're at least consulting with MIT.

"Computer issues?" Really, couldn't they at least think of a better excuse? Though I admit it does sound better than saying, "we delayed the implementation to continue diverting money from the premiums to our shareholders."

I don't want to paint all health insurance companies with the same putrid brush, but as a doctor (or, as they say, a "health care provider,") I think the average person doesn't realize that these companies are first and foremost in the business of making money for their shareholders. If they can provide health coverage along the way, great, but they aren't in this for their health. Nor for yours.

103 comments:

brockton said...

Nope. Why do we allow health insurers to be for-profit? The incentives are totally out of line.

I don't know why center-based insurers have gone out of style. I remember being part of Group Health as a kid - all our doctors were in the same building (dentist even!), no separate trip to the pharmacy, and I don't think there was this niggling accounting stuff, since everybody had the same insurance - I presume the doctors were salaried.

I guess surveys show people really hate the idea they might not be able to go to whatever doctor they want. Seems to me if you wanted to go outside the center in a plan like this, it could be handled the same way "out of network" visits are in modern plans.

Somebody start a medical co-op! I'd join!

DR. MARY JOHNSON said...

Chuckle. Good post.

mumkeepingsane said...

I enjoyed reading this post. I am forever amazed at the US health care system.

AshleyC said...

A-M-E-N!!!

N=1 said...

You meant "Untied," didn't you. Yep, know 'em well. Their response - you can have all the healthcare you have, we just won't pay for any of it.

I blogged about the mandate of corporate healtcare to profit, but your story is much more compelling than my rant!

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Anonymous said...

As a newly graduated, practicing physician, I find myself aggravated with health insurance companies as a physician, AND as a patient. I'm a healthy female under 40, and I just got a several hundred dollar lab bill because the PA who did my annual physical ordered somewhat esoteric tests with no real treatment value that are not covered by insurance (Vit. d? please!). Nevermind the thousands of dollars we pay annually for our healthcare. Do we really wonder why the system costs so much? and we get so little?

Mike Miller said...

We've had group health insurance for the last 20+ years. In the last 4 years we've had to actually use it and it has been pure misery. Sure, everything is covered when you buy the policy but things change when you start using it. In-network / Out-of-Network, sheesh, seems like you don't stand a chance. If something is out-of-network then standard/customary doesn't apply so everyone can try and get you for everything they can. WHAT A MESS!

I pay nearly $6,000, and growing, in premiums every year. We've had 2 out-patient surgeries in our family in the last two years, and have maxed out the rest of our insurance requirements but still paid more than $5,000 out of pocket. The basic math says we paid more than $11,000 each year for health coverage protection. Initially, you would think the insurance company took a hit on us because of our expenses but since they only pay the medical community a reduced amount called "Usual and Customary", I am sure they still made a considerable profit at everyone else’s expense.

So, why do I have insurance?

Complaining hasn't done me or anyone else I know any good in this arena so I'm proposing a new PUBLIC outcry. Please visit my website http://www.stoprapingme.org and get involved. There are images to send to people that they might send to others, and they . . . Hopefully we can mobilize a public outcry, determine some stop-gap solutions that will start a reform action.

How do you eat an elephant?

Britany said...

Keep up the good work.

Uomiwon said...

Yes, Health Insurance and the Medical profession both suck...
My former company started this mess for me, they got caught up in this whole "deductible/out of pocket is less expensive scheme". We switched in April. Come Nov/Dec my family developed medical problems. I was trying to keep up as we went, paying "my share". Come to find out the people I pay don't tell the insurance companies what I've paid and the Insurance companies don't ask and could care less. Which is why I know I've paid more than my so called fair share, which is another point entirely. Now back to what I was complaining about, most of the bills started hitting in january. Which by the way comes after December, which is coincidentally the last month of the year for the deductible and we got to start all over. So, Come January/Feburary here I am meeting a whole new "deductible". This sucks! To top it of, my company goes under in March. Hello, now I'm paying $1000/month for cobra. Unfortunately, I cannot get my own Health Insurance because I have Diabetes. Terrific, I'm in great shape aren't I. But, thankfully I get a new job. Crap... A new Deductible. Except this one is bigger than the last one. Plus it costs me more per month. Now I'm drowning in medical bills. Just shoot me now. $9000 out of my own pocket, not including what I paid in premiums... For ACL surgery alone (This does not include the former two deductibles). I realize, I can't go to the Auto shop to have this done. But, it's not freakin brain surgery. $56,000 was the original bill from the hospital alone... for Eight hours of work. Eight hours? That's like $7000/hour... Isn't that what Michael Jordan made? Granted... I've met my deductible and out of pocket and I don't have to pay anything else for the rest of the year (what like a whole month?). If this is what I have to look forward to every year for the rest of my life... just shoot me now, someone else can collect whatever is left of me.

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