Tuesday, October 26, 2010

Lions, and Tigers, and Government Bureaucracy, Oh My!

- Rejecting a series of claims because 72-hour pre-approval was not obtained, even though they were urgent procedures, scheduled within 72 hours.

- After accepting the lack of possibility of preapproval, re-rejecting the same claims outright on account of minor coding discrepancies between planned and actual procedure (example, MRI with contrast vs. MRI without contrast).

- Denying an inexpensive eye exam for headaches, since routine eye exams are not covered, and then denying a subsequent neurological exam, since there were simpler, cheaper options for diagnosing headaches.

- Doling out permission for physical therapy visits one at a time, even though we're entitled to 30 annually, sometimes so slowly that there were uninsured visits while waiting for permission for subsequent insured ones.

- Excluding inexpensive, money-saving public health initiatives from insurance coverage, like flu shots and HPV vaccinations.

- Imposing a low lifetime maximum, such that one major prolonged illness or serious injury could potentially lead to the termination of coverage. Continuing to do so even after recent health care reforms made this illegal, since they're grandfathered.

- Charging $400 for each physical therapy appointment (found out after 11 visits, and one whopper of a bill), as opposed to the usual $20 for the same exact services, because the physical therapist in question performed her occupation in a non-hospitalization, walk-in clinical wing of a building that they classified as a 'hospital' instead of a 'physical therapist's office.'

- Treating a series of claims at a state's largest hospital as out-of-network, even though other patients who buy insurance from the same company, headquartered in that very state, are considered in-network.

- Denying a post-surgical hospitalization (and the entire hospital part of the surgical bill, as well) because the patient, who was under anesthesia, didn't call to say he'd be staying at the hospital after the procedure.

- Raising monthly premiums mid-year, without notice, and simultaneously raising that premium retroactively, debiting the excess amount from a personal bank account without permission or notice.

- Rescinding said retroactive increase under pressure from a state agency, but keeping the immediate increase going forward, even though both are equally illegal under state law.

- Pulling the same exact illegal stunt 2 years later, and attempting to argue, once again, that they're allowed to do it. (They're not.)

- Raising our monthly premiums by as much as 34% per year, with no increases in coverage.

- Terminating our benefits plan at the end of this year to sell us a watered-down package of benefits next year at an even higher price than we currently pay.

Off the top of my head, these are a few of the indignities that my family and I have suffered at the hands of our private health insurance providers over the past several years. (If you throw in Medicare Part D, the private, for-profit prescription insurance that my grandparents have, you can add really lousy drug benefits and 'donut holes' to the list, too.)

Please tell me, how could a government-run, single-payer system possibly be any worse than this?

The word 'socialism' by itself does not constitute a valid argument against better, more efficient health care.

Higher taxes are not a compelling reason to oppose it, since businesses and individuals are currently devastated by the astronomically high expense of privately buying health care, essentially a huge tax.

'Government control of health care decisions' is not a very compelling argument against it, either, since right now teams of for-profit executives and administrators already tell us what doctors we can see, how often we can see them, what procedures they're allowed to offer, and how much of the bill we'll get socked with.

So, again, what's so good about the system we have now? And what would we lose by implementing 'Medicare for all'?


1 comment:

Anonymous said...

Their business model is to take in premiums and deny, deny, deny. Medicare has a 7% administration cost, the private plans show a 27% cost. What is the difference? The plans give so much money to congressmen and the president for their campaigns, that they own them. That is why the public option failed, that is why there is no proper supervision. That is why, under the new Supreme Court rulings, things will just get worse. When do we take to the streets?