Wednesday, October 21, 2009

Insurance companies are douchebags

I am my insurance company's worst nightmare: someone who needs health care. Insurance companies make money by having a bunch of people pay an arm and a leg for health insurance and then staying healthy and never using their policy. That's how they make a profit and have enough left over to pay their CEOs over $100 million in bonuses every year.

I have what is called a "preexisting condition," or a health problem, and this makes me completely uninsurable. As long as I maintain constant health insurance without any breaks in coverage, insurance companies will always have to cover me and cannot claim "preexisting condition" even if I change from Blue Cross/Blue Shield to Aetna or United or whoever. The minute my coverage lapses, I am screwed and will never get health insurance again. The companies will be able to shrug their shoulders and say "sorry, preexisting condition, not our fault so we shouldn't have to pay for it."

My mom's insurance (BCBS) covered me up until my 25th birthday and then I switched to COBRA coverage. COBRA is for people who used to have health insurance but are now no longer insured; usually people who loose their jobs, but I know a lot of young adults who get COBRA when they are forced off their parents' policies. It allows you to keep the same policy you had but your employer pays less towards your coverage, so you end up paying a heck of a lot more than you were. Right now in order to keep me insured we are paying more for just me under COBRA coverage than for the other four members of my family. And COBRA is a pain in the butt - they send payment forms days before the payment is due, if you are late with payments they cancel your coverage, it feels like one gigantic trick to get you to become uninsured. It probably is. I would guess that most people who bankrupt themselves getting COBRA are people who need an insurance policy.

On Monday a woman from the business office came to my hospital room and said their information showed that my policy had lapsed. I assumed it was some weirdness with changing between being on my mom's policy and being on COBRA, and I assured her that I had paid for coverage and had the reciept. She said ok, no big deal, if it hadn't been fixed in a week she would come see me again.

Imagine my surprise when I told my mom about this incidient and she said "yes, I've taken care of it, don't worry about it." This set off alarm bells. Taken care of WHAT?

Apparently BCBS tried to claim that we had been late with September's payment and therefore my coverage was forfeit. They sent a little letter to the house saying I was uninsured and everything. I know that I paid that bill before the end of September and I remember having thought "I had better make sure I put this receipt in a safe place because you never know what these SOBs will pull." This was a couple of weeks before I was admitted to the hospital. I was so right. They gave us some BS about recieving the payment on October 8 when the receipt shows I paid on September 21 AND the bank statement showed that the check had been cashed on September 25. The situation has been taken care of, following what I can only imagine was a very scary phone call for the poor schmuck at the insurance company. My mom can be very, errrm, persuasive, especially when it comes to her kids. What a bunch of douchebags!

There is no doubt in my mind that they saw the huge influx of hospital bills for me, checked into my record, saw that my claims were not going in a good direction, and decided to try to get rid of me. Luckily we were prepared and knew what to do, but what about someone who may not have known that what BCBS is doing is wrong, or someone who had paid in cash and then lost the reciept? They would have been totally screwed, and not through any fault of their own, through the tricks of the insurance company! These insurance companies are a menace to society. If we do not pass health insurance reform this year I will be seriously disappointed and PISSED OFF. At the very, very least they have to get rid of this "preexisting condition" ridiculousness and stop insurance companies from dropping sick people.

I know my family would do everything they could to pay for my care - sell the house, get huge loans, take on second and third jobs. But it would never be enough. My medical bills are already way over $1 million for my lifetime and we're staring another $1 million in the face for a second transplant, medications, follow up visits, etc. No one should have to resort to such extremes simply to live. Health care is a right. Note that our founding fathers did not include "profit margin" or "bonuses" when they wrote the Declaration of Independence, but they did include the right to LIFE. Modern medicine is a miracle and everyone should be able to profit from it.

Apologies to anyone I may have offended with my use of coarse language, but sometimes the only true descriptions come from bad words.


Jennie said...

It literally makes me sick to think about my friends and family back home who have no insurance. It is a basic human right like food and water and no one should ever be denied access to medical care. That's why I hate the US (well, the Republicans who oppose the public option) so much right now. Everything is great if you're rich, but if you're not, then too bad for you.

Leesa said...

EEK!! And GASP!! I can totally believe they tried to kick you off their insurance coverage and BOY am I sooo glad that you guys had it all taken care of.. Soooo sneaky of them... I cannot imagine someone who paid in cash or didn't have the records to back up the payment, like you did.. They'd be sooo screwed!!
Gooo mom! That's cool your mom can be so persuasive... If you need me to speak to those schmucks.. and NOOO I don't mean jewelry stores, let me know!!!
Take care, Leese

Monique said...

Yeah I got dropped from my coverage when I tried to break off my parents' account and get my own with blue shield.

They knew I had TMJ, and when I was no longer a dependent, they said F you, that's a preexisting condition..... and it's a super minor condition anyhow. So I lied on my application to Kaiser and said I was perfectly healthy. It was the only way.

Health insurance is a joke.

Rose said...

The thought of how you were paying for your medical care had crossed my mind; thanks for explaining the absolute bullshit that is the American market-driven healthcare system. Why is a social policy driven by profits?? Is public education decided by how much money it will cost? Not de juris, but perhaps de facto. Oh my goodness. Write to your senators and representatives. And Obama. I pray, and seriously I do, that your health does not suffer because of fucking bureaucracy. Your mom is amazing, btw.

Andromeda said...

Your mom sounds like mine, lol. Just the hint of anything fishy with bills and she sits there in the office yelling at anyone and everyone. I used to be annoyed by it, but then found out how useful it can be when dealing with Orange.

So glad it got sorted out, and hopefully we'll be the last generation to have to deal with this insurance nonsense.

Anonymous said...

Oh no! It's exactly what you don't need at a time like this, I can't believe they are trying to screw you over, bastards! Glad your mum dealt to them and hopefully no more nightmares with the insurance company. I don't really understand how the insurance works in the US, all I know is that when I travelled there I had to pay loads more of travel insurance and I had to call them before I needed medical care in the US. Bon courage!

Amanda said...

This is beyond wrong. Egh. Beyond a nightmare.... I'm so sorry. This is the type of nonsense we read about in my insurance law course.... Blugho. As for the language in your post, on the contrary, I found it was not nearly strong enough. Also, that bit that "Kiwi in France" said about having to call the insurance before getting medical care is also really obnoxious-- over this past summer I broke my foot in the U.S. while crossing the street. When one is driving one's self to get medical attention with a broken foot (I woulda hated to see an ambulance bill for even something trivial like that!) about the last thing one wants to contemplate is calling up the insurance folks to get it "pre-certified." Likewise, this nonsense with your insurance right now should be the last thing you should have to be thinking about. *sigh*

Mary Community Farm Kitchen said...

Well, the really wild thing in the health insurance mess is the fact that it's trying to be a "for-profit" business system. There's never going to be profit to be made keeping someone healthy--there's no product to sell, and as others have pointed out, it's a human right. Is one life more valuable than another?

Mary Community Farm Kitchen said...

Ps. Those who think they might want to support the work to have a public option as part of the health care reform might consider donating to's campaign. They've created a kind of adorable ad and they're trying to get it on TV. Check it out here:
Sorry for being political, but some folks may want to turn anger to action, and giving money can sometimes be a good way. ;-)

shannon said...

Insurance companies are such douchebags! I am in total agreement with you! I'm glad you and your family know how to deal with them. I'm not glad that they had to add this to your mind during this not fun time.

au soleil levant said...

I think we should make everyone in Congress have to put up with a normal American health plan for a month and then see how quickly they change the way health insurance is run in the US.

We all agree that the US non-system sucks, so what the heck is taking them so long to figure it out?

Zhu said...

I remember you told me once that you had to go back to the US because otherwise you would have trouble with your health insurance.

This is actually something I was curious about, since most non-Americans think the system over there is pretty harsh and unfair.

The nerve of this company is unbelievable. I understand that insurance and not non-profit companies but there are limits to their greediness. Public benefit shouldn't be driven by profit!

So, how do you do? Is this insurance a private one that you pay out of your pocket (I don't think you were working, right?)? How do most people do?

Barbara said...

Hi Mira,

This really sucks for you !! I say first, bless your family for doing the 100+% of what they are doing, but they can't do it all .

You were so smart to keep your receipt for you, and I know that you will be a tought cookie with them too.Fight for your right !!!

I'm going to be doing a change in my blog soon. But, I'll still be around.

Bye for now ;)

au soleil levant said...

Barbara - can't wait to see the changes to your blog. Thanks for the encouragement.

Zhu - insurance is so much more complicated than it has to be in America. Some people do have government run health insurance - the military, Medicare which is for people over 65, and Medicaid which is for the very, very poor.

Most of the rest of the US gets insurance through their job, and this insurance is purchased from a private company like United, Aetna, Blue Cross/Blue Shield. University students can purchase insurance through the university, and children are covered by their parents' policies through at least age 18, although in some states and with some companies they will cover you during university or up through age 25, like my mom's policy. You can also buy insurance on your own without the help of an employer, but it is reallllllyyyyy expensive. In employer-based coverage the employer pays a large chunk of the cost of insurance and then the employee is responsible for monthly premiums and copays when they use the service.

The COBRA that I have is the same policy that the rest of my family has, but my mom's employer pays a smaller portion of my coverage, so we end up paying more out of pocket for my coverage.

COBRA can only last for 18 months, so in a little over a year I'll either have to be employed with insurance, at a university that will offer me insurance, or we'll have to start buying insurance independently. That's why I said that I have to come back to the US because of the health insurance problem. If at any point I find myself uninsured in the US, I will never be able to get insurance again because the companies will claim that I have a "preexisting condition" that they don't have to cover. I have to be sure that I am always covered in the US, or make the decision to move to a foreign country and not ever come back here to live until they reform the insurance system.

Does that make sense?

Zhu said...

Your explanation makes sense... the system doesn't!

I understand your situation now. But I still find it a bit crazy... well, nothing new here, I guess nobody will be offended if I state that the US health care system sucks.

Do a lot of employers offer health insurance? In Canada, we have "social benefits". Basically, some employer offer an additional coverage for health care that is not covered by the (free) provincial: typically, dental insurance, glasses, medicines. But few employers offer that, you need to be in a very big company (I'm guessing IT companies for ex.) or working in the public sector.

This pre-existing condition clause is crazy too. I acknowledge that you do have a serious condition. But I'm guessing that a lot of people are turned down for quite minor conditions and that it can be very tricky. I would probably be denied coverage as well.

How many people have cancer in the US? How many have AIDS? How many have mental disorders or other health conditions? And how many are denied health coverage? That's nuts!

Zhu said...

Sorry for ranting BTW. But I believe we are the same age and I feel for your troubles.

As a Canadian, I can't believe the USA, a modern and otherwise pretty great place, is having this kind of backwards system.

au soleil levant said...

It is very true that we have a terrible "system" - when I took a class about our health care system, the professor said we actually have a non-system, and he's right, it's a pieced together, totally uncoordinated set of organizations.

Employer based insurance is slowly eroding because health care is so freaking expensive in America. We spend almost twice as much per person on health care than you guys do in Canada and it increases every year. Employers can't afford to offer health care so they either drop it or employees forgo raises in order to keep their health insurance benefit. And yes, it is mostly large companies that offer insurance because small businesses with few employees face much higher costs because they have fewer employees among whom to spread the risk.

People get denied coverage for ridiculous things. In Sicko Michael Moore profiles a woman who was denied coverage because she had failed to declare a yeast infection, or I just read about a woman who was denied coverage because she didn't tell the company that she had seen a psychiatrist a couple of times after her dog died when she was 8 yeard old. They will stop at nothing to preserve their bottom line and deny coverage to everyone.

(Side note: in general I didn't think Sicko was very well done and don't necessarily recommend it)

There are 50 million people without health insurance in America. It's shameful and outrageous and makes me unbelievably angry that some people don't want to fix that. Americans are crazy.