I Hate Insurance…
The first-ever series of layoffs I experienced resulted in me scouring the Internet high and low for seemingly reputable inexpensive online insurance brokers. I settled on ehealthinsurance.com and went through a fairly easy application process. That was a year and a half ago.
Since I have recently been placed in the same situation, I went back to ehealthinsurance.com to reapply. Fortunately, they kept a percentage of the information I had entered last time, accelerating the data-entry process somewhat. Instead of going with HealthNet, like I naively did last time, I jumped off that ship and decided to stick with Blue Cross of California, my health insurance provider when previously employed at Flextronics. When I reached the section of the application where they make you bend over and remove small pieces of your large intestine (similar to the financial strip search you undergo when applying for a home loan), I put in as much information on my family’s prior clinic and hospital visits that I could remember, listing visits to Sunnyvale Medical Clinic and Good Samaritan Hospital.
A week later, I received a letter in the mail stating that “the medical history in our files indicates the following health care providers have been seen.” They go on to list Camino Medical Group and San Jose Medical. The letter continues, “This information was not included on the Individual Enrollment Application. As a result, we are unable to process your application for enrollment.” So, because Good Samaritan Hospital is now part of San Jose Medical, and Sunnyvale Medical Clinic is part of Camino Medical Group, they rejected my application because of the mismatch. Even a phone call didn’t help.
I’ve reapplied, adding the information that they themselves gave to me. Does it make sense to deny insurance to someone because they didn’t disclose or didn’t know about what the company already knows? When it comes to insurance I guarantee that their records are better than mine. Sorry, but there’s something wrong with the system when they can tell you “We’re denying your coverage, even though we’ve been your most recent provider, because you were supposed to tell us every office visit or medical treatment you or your family has had that we’ve paid for and we have all of the records for.”
We’ll see what next week brings. “I’m sorry, but you’ve been denied coverage because:”
- you misspelled “dermatology” in Section 6C.
- you did not disclose the fact that you had a plantar’s wart surgically removed by Dr. Mel Practis just below the metatarsophalangeal joint on the big toe of your right foot in 1984.
- your second-grade teacher’s middle name was actually “Yamamoto”, not “Fujimoto” as previously stated in section 14G.
- we detected an unauthorized use of our customer service center via telephone from your primary residence without a referral from your primary care physician, which is against established underwriting guidelines.
- we don’t actually accept online applications. eHealthInsurance is actually a business unit of the al-Qaeda. Because you provided them with all of your personal information, your stolen identity will be used to generate fake passports for terrorists.
- we feel like it.
Have I mentioned that I hate insurance?
Oh, don’t get me started. Oops, too late. I’ve changed employers several times in recent years and, consequently, insurance companies. Even when we’ve ended up back with a provider that we’ve had before we have to start all over again to convince them that a particular medical expense is in fact covered under their plan. In one of the most recent disputes we got a call that they were going to retroactively deny coverage for treatment that they had already been paying for. They want us to reimburse them. Why the sudden denial? Because they don’t like the equipment the physical therapist is using. It’s a licensed PT at a facility licensed for physical therapy to which we were referred by our primary care physician. And they are going to claim they shouldn’t have ever paid for it because they don’t like the type of therapy ball being used. The fun part is the ludicrousness of the phone calls. We don’t cover mental therapies, they say. It’s a physical therapy, we explain. Oh, well it isn’t at a licensed location. Yes, it is. But it isn’t authorized. We sent you the authorization months ago. Ah, yes, I see it right here but we can’t cover because you didn’t tell us what the actual outcome is. The treatment objectives were included in the authorization and how are we going to know the *actual* outcome before therapy actually starts? etc. etc. etc. It’s like they have a list of excuses that they run down trying to deny coverage. Every time we point out that they just don’t know what they’re talking about they move on to the next rote objection on the list. It’s like they aren’t even listening to the things we are trying to tell them. We’ve gotten bills from the Stanford Children’s Hospital that have no explanation of what we’re being billed for. Basically just demands for money. When we’ve called to find out what visit the charge relates to it’s been difficult for them to find out. Each visit gets a different patient account number. See a doctor and have 2 follow up visits? Get three different account numbers. Imagine if they did that with the actual medical records. This week THEY sent US a check. Again, no explanation. So we call to find out why and give them the account number and the account is for someone we’ve never heard of. Do their records show a refund is due to this Mr. X? Nope. I suppose it is hard for your left hand to know what your right is doing when your head is so far up your ášš. At least Enron KNEW that their accounting was screwy. Stress and frustration make you more likely to get ill. I’ve got to suspect that it would actually be cheaper for the insurance and medical companies to just cover what they are supposed to in the first place, than to pay for all the resulting office visits and medications.