Health Care Rants

I need to rant about health care now.

Here is my personal story:

Back in September of last year I finally decided that you know, I should have health care. My parents were telling me, it's not safe to not have health care. You need to have this coverage. I buy it. I go online and buy personal health care coverage for myself. I have to pay $120 every month. Considering that I am a healthy, young female, this seems a bit outrageous. Everyone tells me - it's the only way to be safe, in case of a catastrophe. In my coverage it says that "preventative visits" are 100% covered. Not even a deductible! I decided to go and test that out. I made an appointment to see an OB/GYN. (I haven't had an annual exam in years because I didn't have insurance).

I go in, a bit apprehensive. But, I have a wonderful experience with my doctor and his assistant. I think - oh this is great. I'm paying all this money to my insurance company for this. It is paying off!

Then, I receive a Explanation of Benefits (EOB) from them. It says they will cover a procedure that my doctor billed them for. Good, this all seems right. The next day I receive three more EOB's. These state that they will not cover four different items billed to me by "Medical Diagno" and they will not cover two other items that my doctor's office billed them for. If I am charged the full price, which I could be, I would owe almost $700 for this visit, which was supposed to be completely covered by my insurance.

A few days later I received a bill from my doctor's office stating that I owe them $146. I have still not received a bill from this mysterious "medical diagno"

I must first state how terrible these documents are. They do not explain what my insurance is not covering. They are just items from "Medical Diagno" for $130. The column the title is printed in cuts off the full word. (The insurance repriced this mystery item at $19 - which basically means that if the insurance pays for it they would pay $19 but if I have to pay for it, I could pay $130). They also sent me a letter explaining that I have a right to appeal these. On the bottom of the page they list a number for the Texas Health and Consumer Protection Bureau. It states that they can help me with the appeal process. This letter looks like it could have been typed on a type writer from the 1950's.

Yesterday, I finally had time to follow up on all of this. I started with the Texas Health and Consumer Protection Bureau. They asked if I had already filed an appeal. I said no. They said I needed to talk to my insurance company first.

I called the insurance company. After being on hold for nearly 10 minutes, I spoke with a real, live person. I asked her about the denial of coverage. She said that they do not cover the visits. I said that my policy should have covered the visit, as it was preventative. (Now here's the real kicker, if I had gone to the doctor because I was actually sick - that is clearly NOT covered under my insurance). She said that my doctor's office had coded this visit as a visit related to an illness.

I then called my doctor's office. They're closed on Fridays. I have to call back on Monday to follow up on this.

Even if my doctor's office did make a mistake, this does not address the other four mysterious charges from "medical diagno". I asked the woman that I spoke with what they were for and she said that I would have to ask my doctor about that. She could not tell me.

I guess I'm still in the middle of figuring this out. I did cancel this insurance coverage shortly after my visit (before I got any EOB's) because I was picked up on employer's insurance coverage.

I've now given you the basics of my situation. I think insurance companies are some of the worst ideas ever sold to the American People.

Basically we are paying them lots of money so that they can pay for our health care if we ever get sick. However the plan that I was paying into specifically excluded paying for any doctor's visit because I was sick. Why am I buying something that I cannot use? I am buying it for the emergency scenario. God forbid, I get in a car accident or fall and break my leg or something else. They would cover a portion of that after I've met my $5,000 deductible. If I just have a cold or Bronchitis (which I actually did have recently but thankfully my new insurance actually covers me going to the doctor for a minor illness and all I had to pay was $25 plus a portion of my prescription). I was paying them every month, but if I ever had a minor illness I would have to pay for that on my own.

Medical providers are inflating the costs of their services. As shown in my EOB that I received from my insurance company the "cost" of the item was $130. My insurance company had negotiated a lower rate of $19. I have no idea of what the actual cost of this procedure is (I still don't even know what "it" is). Let's look at this from a purely financial standpoint. All companies have to make a profit. Let's imagine that they are charging the insurance companies at cost. Let's say they are not losing any money by charging my insurance company $19, but they are also not making a profit. Where does the profit for this company come from? It comes from all the people who either are denied coverage by their insurance companies and so have to pay the full value or they do not have coverage at all and so have the pay the full value. The "costs" are highly inflated, 684% by my basic estimation. If the real cost was charged to all customers would insurance even be necessary? The uninsured and those that the insurance refuses to cover are the ones that pay this price.

I'm very concerned that when the Supreme Court Rules on the Affordable Care Act this summer that they will side with the Government. I know that I'm progressive, but I don't believe that these corporations need the force of law to make us buy a product that should be a basic right. Access to affordable health care (and possibly free?) is something that the Government should provide. The government needs to provide the things that people cannot provide for themselves. Among these is affordable health care. We have a right to life, liberty and the pursuit of happiness. If people die because of a lack of health care (which happens every day in this country) than the Government is not holding up it's part of the bargain to ensure that we have these rights.

It is time for the American people to stand up and demand a single payer system for health care that removes the profit motive.