The Health Insurance Machine

It's an undisputed fact that health insurers serve only one purpose - to make money for their owners and shareholders.  They do this by using any legal means available (and even some illegal means) to rake in cash from people who rarely get sick and deny coverage to folks who might actually need more than cursory attention.  Insurance companies do not care if your daughter has cancer, or if your wife suffers from chronic pain, or if your husband needs an operation to keep him alive.  They. Do. Not. Care.  Representatives might make soothing noises when they speak to you over the phone, they'll direct you to a clinic or supply you with a list of doctors on the network, some may even express sympathy for your plight.  But make no mistake.  The health insurance industry is driven by profit, and there's no profit to be had in seeing that seriously ill people receive the treatment they deserve.  So they deny coverage. 

As more Americans lose jobs, more folks are having to seek out private health insurers in order to provide health care for themselves and their families.  John Dorschner at the Miami Herald discovered that insurance company "guides" for denying coverage occasionally pop up on the Internet:  This confidential information on some insurers' practices is available on the Web - if you know where to look.  What's more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs...  The problem is, material available on the Web shows that people who have specific illnesses or use certain drugs can't buy coverage.  "This is absolutely the standard way of doing business," said Santiago Leon, a health insurance broker in Miami.  Being denied for preexisting conditions is well known, but when a person sees the usually confidential list of automatic denials for himself, "that's a eureka moment. That shows you how harsh the system is." ...Among the health problems that the guides say should be rejected: diabetes, hepatitis C, multiple sclerosis, schizophrenia, quadriplegia, Parkinson's disease and AIDS/HIV.

From InsuranceCompanyRules.org:  It’s bad enough that insurance companies are allowed to block health care for patients’ "preexisting conditions."  Making matters worse is health insurance companies’ manipulation of this loophole to deny claims they’re supposed to be covering under their own agreements.  Just look at Assurant, ordered by the Connecticut Insurance Department in 2007 to pay restitution to patients whose claims were improperly squashed by the company’s subsidiaries, based on supposed preexisting conditions.  In the words of the state Attorney General: "Assurant calculatingly denies coverage for catastrophic illnesses….Assurant promised benefits, but abandons them when they face cancer and other devastating diseases." 

ICR found a 2001 e-mail from Amerigroup’s Illinois director of medical management that said:  "Please keep up the good work with the marketing reps of not trying to sign up pregnant women."

We have turned over our health care to a cool and impersonal machine whose engine must be constantly greased with money.  In return for maintaining the machine, we're assured that it will continue to sputter along, performing no useful function and dedicated to nothing besides its own existence.  We should scrap this piece of junk and start afresh. 

Comments

[Jenny]

Agreed!! Insurance companies not only jerk around the patient/potential patient, but the physician as well. Working in a multiphysician practice, I see it every day. The newest insurance prescription 'practice' is to 'tier' their drug coverage. Starting in January, 09, many insurance companies are requiring patients to try cheaper and potentially less effective medications before the company will pay for the more expensive meds. This is happening every day - a patient who has been on a med that has worked very well for them for years, is being denied a prescription for that med until they go through the 'tiers' of meds. This means the patient bascially has to start over on medication therapy trying ineffective meds and working their way back up to the med they need before the insurer will pay for it. OR - the physician can submit a preauthorization - citing reasons and medical documentation citing why the patient must be on the medication. This is a lenghty process, requiring nurses to be on the phone with insurance companies for 20 - 30 minutes per patient, submitting paperwork and if it still doesn't suit the insurance company - DENIED! A preauthorization can take up to 10 days for approval - sometimes patients have to pay out of pocket for a short supply of medication so they don't run out - or they simply go without if our office has no samples. Dispensing cheaper meds may help the insurance companies coffers - but all that expense is being passed on to the physician's with man hours wasted, which will eventually be passed on to the hapless patient in the manner of higher office rates. I take calls daily where someone from the Phillipines or Mexico (yes the insurance companies outsource to other countries where employees can barely speak English, let alone pronounce medication names) says "Our insurance prefers the patient to be on 'this' medication!" Since when did someone in an insurance company know better than the physician who evaluated the patient??

I pray for the day when Obama has the time to slap these insurance companies back in their place and allow physicians to get back to the business of treating patients.