Everyone who thinks that all American entities should make a profit, remember this: before we had our current "socialized" police and fire departments, these functions were performed for profit by gangs of street thugs who demanded payment before responding to a crime in progress or dousing a fire. In case of fire, if you hadn't paid off a particular gang or didn't pony up the cash, your home or business would burn, frequently taking the whole block with it. Whichever gang arrived first supposedly got dibs on fighting the fire (and getting the payment), but often several gangs would arrive simultaneously and battle over who was going to get paid. Meanwhile, the fire would burn out of control. This was a major factor in the 1837 conflagration which consumed Manhattan's entire downtown business district, including the merchant exchange and the post office. Some of you may recall this state of things from Martin Scorsese's film "Gangs of New York," about the Five Points neighborhood in the period surrounding the Civil War. There were numerous historical inaccuracies, including the conflation of the Draft Riots and other gang uprisings, but the general lawlessness and misery were not exaggerated.
This is sort of what happens with health care these days, only it's the insurance companies who are fighting not to pay for your care, and they don't have colorful names like the "Dead Rabbits," but soothing marketingese names like "Humana," when they should be called "Inhumana." While you and they fight over who's going to pay your doctor bills, you might get sicker and die before you can sue, or you might give up because you're too sick and tired to fight, or you might just pay up. All of these outcomes benefit the insurance company, which then doesn't have to pay. And now that they've got you on record as having an illness, they can refuse future claims or insist that these must "count towards a deductible," which is always, always the default position on a major claim.
In my experience, I have never had an insurance company cover everything it said it would, including basic care items such as mammograms (deductible), routine annual labs such as pap smears (deductible), ER visits (deductible), and even hearing tests (outright refusal). They always manage to weasel out of paying and threaten my credit history if I don't pay.
The ACL reconstruction surgery I had 15 years ago was preapproved and precertified, and I used an in-network orthopedic surgeon. In return for this, 100% of my costs were supposed to be covered after my co-pays. Instead, I got nasty letters on red paper for five years afterward, telling me that I owed more than $2,000, and threatening my credit rating. At one point, I lost a temp job because I went over my lunch break by two minutes while trying to sort out this problem for the umpteenth time.
Even though I used an in-network doctor and hospital, the insurance refused to pay for the pathologist because they claimed he was "out of network." The pathologist examines the bits that are excised and affirms that the right parts were cut, although if the surgeon has gotten it wrong, it's too late to rectify the situation. I didn't even know a pathologist was necessary until I got the bill; I certainly had no say in who he was, since I was under anesthesia at the time, so how would I have protested? I wondered if I were really supposed to rise up off the operating table in a morphine-induced stupor and ask, "Etthhkyoothe meh. Ith thath an in-nehwuk fpthologst?"
August 1, 2009
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