Danged Health Insurance
Tue., May 13, 11:48 AM
My thanks to purple chai for getting me back on track. I have been so angry with my insurer that I couldn’t see straight, but she did remind me of some of the funnier errors they’ve made.
I remember what happened to my friend Gloria many years ago when we worked together. She had the misfortune of having the same surname as her doctor, and by the time they finished, the insurance company had her married to the man!
I’ve written about how I haven’t had proper health insurance since I was “downsized” ten years ago; how I had some minimal insurance through my temp agency – until they switched me to COBRA because I didn’t work enough hours; how I finally was able to afford private health insurance by using my social security plus my IRA. Yes, it’s expensive, but it covered stuff I was paying out of pocket, and it gave me some peace of mind. I don’t have much choice in looking for insurance because I am old and because I have diabetes.
Then last week I got a letter from the insurance company informing me that, due to a disagreement between the company and Yale-affiliated physicians, they would no longer be covering services from those doctors. In this area, the majority of doctors are affiliated with Yale. They are cutting my coverage, but you can bet they won’t cut my premiums. Of course, this may be a ploy to get patients to put pressure on the doctors. Either way, it’s a scummy thing to do. It puts the patients in the middle, instead of helping them – which is what they’re paying for, isn’t it?
I should have been more suspicious. Some years ago I was working for a surgeon whose procedures had to be pre-certified by the insurer. One procedure required three days in hospital, but the insurance company (this same one) would pre-certify for only one day. This lady was a really good doctor, which meant that she spent more time with the patients and less in the office, so I was the one who had to deal with the phone calls: “Your patient, Mrs. X? How come she’s still in the hospital? She was only certified for one day.”
The insurance company hires registered nurses for this job; if their manner on the phone is any indication, their attitude towards patients was probably unacceptable. I would explain that the patient was on intravenous calcium and had to be monitored; that is standard protocol. One day I got so annoyed that I asked the nurse, “How come I always have this problem with your company? The standard is a minimum of three days in-hospital.” And she said, “You’re right, it is. That’s awful!” (She must have been new.)
I had to have a blood test to prove I was past menopause for the hormone study. In the manner of Yale, I had to handle the cost of this eligibility test myself, and my insurer refused it. So I phoned (humiliated to have to call from the office and discuss this matter where I might be overheard), and the representative told me, “we don’t cover skin rashes.” I had to explain in detail, at which point the rep realized that the ID number for that procedure had been entered wrong. That is, I imagine, a common mistake, because data enterers have no reason to be extra careful. But the worst example of that kind of error happened to my dad, though I’m happy to say he never knew about it.
I have to get clinical for a minute. Dad had been having urinary difficulties, and the treatment was to “ream out” the urethra. I’m sure it was uncomfortable as well as embarrassing for him. Then Mother got the letter from the insurance company refusing payment because they don’t cover “cosmetic surgery.” In a panic, she called Sister, who called the insurer. The rep started to explain mechanically “we don’t cover cosmetic…” and then actually read what it was. “Oh, my goodness, I’ll fix that right away.”
One of my aunts, who has since passed away, was a member of an HMO, that invention that was supposed to end all our insurance troubles. When she had a similar problem, the gynecologist wouldn’t even look into it “because of her age.” “Fine,” she said, “why don’t you shoot me now?” (She was in her early seventies then; she had a good ten years to go.) How do people – and their companies – stray so far from their original purpose?
