Games Health Insurers Play

By Karen

I don’t think anyone inspires more fear and loathing than health insurers and the IRS. After an 18% premium hike in January put my insurance within spitting distance of my mortgage payment, I’ve been trying to get a cheaper, higher-deductible policy from the same company. They’ve been dragging their feet.

They’ve already got a file on me dating back to 1992, so you’d think it would be just a matter of changing my policy number. But, no. They needed another application, and now they’re carefully… and slowly… dissecting it.

Last Saturday morning, they phoned to quiz me on a few points. Seems the underwriter had “questions.”

I gave nothing more than what I wrote on my application. There’s nothing to tell. No surgery, no prescriptions, not even follow-up. I felt they were trying to catch me off-guard on a weekend, hoping I’d spill some juicy, life-threatening secret.

The truth is that I have no serious health issues except hypertension (which they aren’t helping), but it’s under control. But it’s disgustingly apparently they’re slavering for any excuse to keep my rate jacked up while providing less coverage.

Meanwhile, the clock’s ticking on my current policy. The premium is due February 1, and I haven’t sent it in yet, hoping for February 1 inception on the new coverage so I can save $110.

My agent says I’m paranoid, and maybe he’s right. He swears I have a 30-day grace period on February. But it wouldn’t surprise me if my insurer drags this out past February 1 so they can:

1) cancel me to create a coverage gap they can exploit (an “accidental” error they’ll take months to correct while I pay more for it), and

2) report the late payment to the credit bureaus to put a ding in my credit rating.

I’ve always dealt with them in good faith, being honest about my health and punctual with payments. They’ve done nothing but evade, deny, extort, and exaggerate minor, one-time ailments from my distant past into time bombs too risky to cover for less than a fortune.

Something is fundamentally wrong with a health system where we’re forced to keep forking over large sums of money to companies whose manner of doing business we find morally and ethically repugnant, and who are too often opposed to helping us maintain the health we’re supposedly paying them to “protect.”

After a Saturday morning assault, I’m bracing for whatever they dish out next.

6 Responses to Games Health Insurers Play

  1. I’ve enjoyed your postings on this topic, but I wonder why, if the IRS inspires “fear and loathing” you’d want to put the IRS in charge of your health care, which is what HR 676 would do. BTW, if you saw WellPoint’s last earnings announcement, which cut the stock price in half, you’ll know that the insurers aren’t putting the squeeze on these days, but the providers (especially hospitals) are the squeezers.

  2. catsworking says:

    Spoken like a true advocate of the healthcare industry. I’ll give you credit for creativity. I’ve never seen it mentioned anywhere that the IRS would be put in charge of a universal healthcare system. The very idea is too ludicrous even for our present government. I’d like to hear how you think that would work.

    I did see that poor WellPoint isn’t raking in as much profit as they would like, and I can’t say that I’m shedding any tears over it. In a more recent post on healthcare, I gave details on recent “Explanations of Benefits” I received, and they showed that my doctors are being paid A LOT less from the insurers than they are billing. I know the same is true for hospital charges, so I don’t understand your contention that hospitals are putting the squeeze on anyone. The only people they have any leverage against are the uninsured who don’t have the luxury of arbitrarily deciding what “reasonable and customary” amounts they’re willing to pay so they can keep their wallets fat.

    It’s the only industry I can think of where the “buyer” of services (when they are actually buying instead of denying) dictates the provider’s pricing.

  3. I was being a little poetic: The IRS was a metaphor for the U.S. government, which will determine how much your doctor gets paid, whether a hospital can install a new MRI, whether you are young enough to “deserve” a life-saving operation or too old and would bust the budget if the government let you have it, etc., under HR 676.

    Currently, the U.S. generally gets too much health care, not too little. (See S. Brownlee’s new book, “Overtreated”).

    The prices on the EOB are determined by the U.S. government, which gives a monopoly contract to the American Medical Association to publish CPT (Current Procedural Terminology) codes that doctors, hospitals, etc. , use to generate claims. The U.S. government (Medicare) dictates the discounts from the CPT codes for which it will pay, and all other 3rd party payers follow. Nobody pays charged prices, but hospitals generate list-price bills for uninsured patients after discharge from emergency rooms and then sends the bills to collection agencies because the U.S. government (Medicare) compels them to do so or the Medicare auditors will throw a hospital that fails to do so out of Medicare.

    Finally, it’s the only industry I can think of where the “consumer” of services does NOT dictate the provider’s pricing through voluntary exchange, but that’s because the individual does not pay providers directly, like we do in pretty much every other area of our lives (except K-12 education, which the government has been screwing up for over a century – twice the time it’s been screwing up health care).

  4. catsworking says:

    Scare tactics won’t work. I’ve already got Anthem’s underwriting department doing a job on me.

    So basically you’re saying that our government is more inept and corrupt than the governments of all the industrialized nations that do have universal healthcare and somehow aren’t killing their populations. In fact, they have longer life expectancies and lower rates of infant mortality than we do.

    I guess you believe that’s the price we must pay for having “too much” healthcare.

    The fact of the matter is that we spend MORE on healthcare than anyone else and get LESS for our money.

    HR676 is not just a Band-Aid for Medicare, but a revamping of the whole system. And it’s gaining more traction with doctors and nurses every day. If they thought the insurers were doing such a bang-up job, they’d be joining forces to kill universal healthcare, but it’s just the opposite.

    I have no doubt the AMA is being forced to play by insurer-imposed rules on compensation, insurers backed by a government they have bought. But the tide is turning there, too, because legislators are feeling heat from the public and the medical community. These days we’re not hearing anybody with even half a brain defending the insurance companies because it’s the sure way to lose an election.

    You raise some interesting points, but I go by my personal experience. I know that I’ve denied myself routine healthcare because of problems with my individual health insurance. And even now that I have it, I’m afraid to see the doctor for fear he WILL find something wrong that Anthem will use against me until they succeed in pricing me out of the market.

    Insurance is the only industry I can think of that leaves no stone unturned in finding reasons NOT to attract or keep customers.

    Unless something is done in the next few years to rein in these insurers – or eliminate them altogether – I feel certain that before I can qualify for Medicare, I will be joining the 47 million uninsured Americans. Do you think I will still be getting “too much” healthcare?

    You sound like a person with employer-provided and/or paid group coverage for yourself.

    I take comfort in the fact that this issue is gaining momentum, and not in your favor. Like it or not, I think the U.S. is soon going to try to join other civilized nations in ensuring that all citizens have equal access to healthcare.

  5. You raise good points too, but you can’t go by personal experience when changing public policy, because in this country there are over 300 million personal experiences! I’m from Canada, and have health-care horror stories up the ying-yang, but dueling horror stories don’t really achieve anything. To look at actual health care outcomes compared internationally, I’d recommend a book published in 2004 by Rowan & Littlefield “Lives At Risk” written by Goodman, Musgrave, & Herrick.

    The insurers don’t force the AMA to do anything: the AMA earns profits of about a billion dollars a year from its ownership of CPT codes.

    Also, there’s no such thing as “universal health care” provided by government. Outside Canada (where the Supreme Court decided two years ago that government-monopoly health care violates citizens’ civl rights), they all have private health insurance. Indeed, Switzerland or the Netherlands has more private insurance than the U.S., where the old and poor are on government programs.

    In Britain (where I worked for years), you’d better have private insurance (“BUPA”) or you’ll be stuck outside a government-run hospital on a gurney. In Australia, reforms in the 1990s increased the share of the population with private health insurance from one third to one half, because the government realized it could not provide the health care people needed.

    Etc., etc., etc.

  6. catsworking says:

    If there really were 300 million personal experiences like mine showing that private health insurance is a hindrance to proper care, it would be a compelling reason to get rid of it. However, I don’t claim anything of the sort.

    You’ve obviously done a lot more research and have infinitely more experience in this matter than I do. So I give up. Let’s just cancel Medicare tomorrow and let all the elderly on fixed incomes with no retiree health plans try to get health insurance on their own.

    If they can’t cough up $5,000+ a month they’d be quoted, in the unlikely event they can find coverage at all, they can just curl up and die. Government stays out of it and the profits of all the businesses concerned are safe.

    This approach would resolve the whole issue of healthcare in the long run. Only the fittest and strongest who don’t need care would ultimately survive. And whenever anything does happen to them, they either bankrupt themselves trying to buy care or die. It’s entirely up to them. No government “interference.”

    This won’t bode well for the long-term prosperity of health-related industries facing an ever-shrinking customer pool. But then, no one will be left to notice when they finally close their doors.

    We’re already a country where nearly 1 out of 6 people has no coverage. In many ways, we’re heading for 5 out of 6. But then hospitals will have plenty of room for only the wealthiest who can afford them.

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