Tuesday, March 5, 2013

Everything That’s Wrong with the Medical Insurance Industry and Then Some

Today I’m in a grumpy mood.

Earlier this morning, I got off the phone with a nationally-recognized insurance carrier about my medical insurance application, and although I’d already given them quite a bit of information about myself AND they’d spoken with my doctor’s office (I was on the line so I heard the entire conversation) they want more. Not content with hearing what my doctor had to say about my health, now they want to SEE my latest lab reports before moving forward with my application.


I just wasn’t feeling it, okay? I’d had enough, so I told them to CANCEL MY APPLICATION, because now they’re bothering me. I was then infuriated to learn that my checking account may still be debited because even though my policy is still in progress, my son's application is complete, and they’re ready to roll! Joy!

Let me tell you a few things about myself. I don’t drink. I don’t smoke. I’m not on any prescription medications. I don’t have high-blood pressure or diabetes. I’ve never been hospitalized except to give birth. I’ve never had any type of surgery. I’ve never even broken so much as my left toe. I have allergies that I control with the Neti Pot (yeah, it’s gross, but it works) and the occasional decongestant. In other words, I am healthy.

However, I am overweight. Not Chris Christie overweight, but more overweight than the carrier is comfortable with. So, they’re going to dig and dig, presumably for the purpose of doing everything possible to ensure that they never have to pay so much as a penny toward my healthcare, even though I’d elected a HIGH-DEDUCTIBLE policy. No, I don’t think so.

And here’s the thing. This carrier may debit my account today, but I guarantee you I’m going to get my money back tomorrow, so you know what that comes down to? Let me break it down:

                   WASTED LABOR (theirs) = WASTE OF MONEY (ours).

When I directed an HR department and was responsible for designing and managing the benefit plans, I saw up close and personal how wasteful certain insurance company practices were. Employee changes her address? Send a new card to everyone in the family. It’ll totally confuse them AND waste money. A twofer! Employee has a problem about a claim? Have him talk to two completely incompetent representatives who don’t know the difference between “coinsurance” and “out-of-pocket maximum” before he gets to someone who can actually help. Frustrated employees love that!  Need to retroactively cancel an enrollment? Do it online. No wait! Fill out this form! No, not that form, this form! 

But at least I am healthy. And while fuming earlier today, it truly pained me to think about someone who isn’t quite as healthy or who has a sick child and what indignities he must have to endure to secure insurance, all for the privilege of paying through the nose for a policy that should at least protect his income in the event of a tragedy but probably won’t. And I thought about individuals being mandated to secure health insurance without benefit of access to an affordable employer-sponsored group plan, and no joke, I got a little sick.

Because understand. I freelance, but my husband works full-time in a large, established organization. Even so, purchasing a family policy through his organization would cost us either $1018 or $2352 per month, depending on the plan elected. I kid you not. Setting aside for the moment the fact that his company is not contributing very much at all toward the premium, what the hell kind of plan costs $2700 plus a month? Remember, you’re talking to an HR pro here, and this is a large organization. Something is seriously wrong here. Seriously wrong. And my experience tells me that there is plenty of blame to go around, but I surely hope someone figures it all out before 2014 comes a calling.

And in the meantime, that unnamed insurance carrier Aetna can go pound sand. 

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