Do You Love Your Health Insurance?

One of the animating principles (or should I say ideologies) of the Obama Administration’s health reform effort is the notion that Americans who have health insurance “like their insurance.”  To genuinely address the underlying problems in our health care system in ways even the President admits would be the most effective — like having some form of national, tax supported health care system, Obama says repeatedly, would “disrupt” peoples’ health insurance.  Well let me tell you from long and hard personal experience and observation, I do not know anyone who “likes” their health insurance because I do not know anyone who likes their health insurer.  People like being insured.  But they do not like the fact that they are not getting what they paid for.  Nor do they like the fact that their health insurance is already being “disrupted’ not by reform efforts but by their health insurance company.

Tell me what other product you purchase — and make no mistake about it, we are purchasing our health insurance even if we get it as a benefit of employment because health care as a benefit exists in lieu of salary improvements — where it is standard operating procedure for the seller not to deliver the service the buyer has bought.  If you go to a store to purchase say a dining room set, and you pay $5,000 for the table with three leaves and eight chairs, does the store routinely deliver a table with one leaf and five chairs?  If you call and explain that you didn’t get the extra two leaves and three chairs do they respond,”well of course you paid for everything but when you sent the check in you didn’t sign in script but rather block letters.”  Do they tell you that you can’t have the extra three chairs because you didn’t explain that you were routinely planning to have eight guests for dinner?  When you made the purchase, did they tell you they were sorry that but you can’t buy the dining room set because you have a pre-existing condition –i.e. you like to eat dinner in a dining room?

Well that is exactly what happens when we spend our hard earned dollars on health care.  Let me give you an example of the kind of “disruption” that is typical under the current system — a disruption that the none of the plans now wending their way through Congress will address.  Last year, my husband traveled to El Salvador to visit my daughter who was working there with an NGO.  Before he left he got a lot of shots.  The travel clinic at the Mount Auburn Hospital offered him a rabies shot but the doctor told him it probably wasn’t necessary because he’d only be away a week.  There wasn’t much risk of him getting bitten by a dog in that period of time.

So guess what, day four of his journey, he goes out for a run, and a dog that’s just lying on the side of the road, leaps out and bites him.  He goes to the hospital to get it disinfected but they don’t give him any Rabies shots.  Needless to say, in a poor country with a lot of feral dogs, no one put the dog in quarantine for ten days to see if it had Rabies.

When my husband got home he told his Primary Care doc about the dog bite and asked about Rabies shots.  That’s a no brainer, the doctor responded, of course you have to get the shots.  So my husband went to the clinic at which is in a local hospital to get ten Rabies shots at the cost of $1000.  If my husband didn’t get the shots and developed Rabies in a few months or a year, he would definitely die — and his death would cost a whole lot more than $1000.  No matter, the insurer wouldn’t pay the bill.  Why?  Because it wasn’t coded as “medically necessary.”  As if he were just bored and wandered into a clinic begging for ten painful shots.

Much back and forthing between us and the insurer and hospital and when the “medically necessary” coding was inserted, the insurer refused to pay the bill because they don’t pay for shots given at a hospital but only in a doctor’s office, clinic or ER.  Much more back and forthing to explain that the shots were in fact given in a clinic that just happened to be in a hospital.  For over a year, my husband spent hours — and I do mean hours — on the phone with the hospital, doctor’s office, insurance company 800 number trying to get the three — not one, three — bill collectors off our backs about these shots.  Finally, he had to call his company’s HR department to get them to sort it out.  Although the bills were finally paid, we are still receiving harassing notes from one of the bill collectors (you got it, none of the arms knows what the others are doing).  The amount of time and money the hospital, doctor’s staff, insurance company, and my husband’s employer had to expend on this beggars the imagination.  Aren’t there better things we could do with our health care dollars?

So this is what happens routinely to those of us who supposedly love our insurance and don’t want our lives disrupted by reform.  I voted for Obama.  Unlike right wing talk show hosts, I want things to work out well.  But the animating ideology has to change if we are to really reform our health care system.  We need a reality check in Washington.  How about this for an idea.  Before they determine how health care should — or should not change — let every member of Congress experience a real private plan as opposed to their socialized medical insurance — for a year.  Make sure everyone in their family has at least one encounter with the health insurance system and then see, do you like your insurance?  Do you want to disrupt it?  I think the answers will be no and then yes.

Showing 10 comments
  • Lawrence Fisher


    That’s the irony of it all: many fear the uncertainty of reform, yet they are fearful and uncertain that their current insurance will truly be there for them when they need it. I would love to start calling this insurance reform instead of healthcare reform. After all, only when the true problem is recognized and identified can anything be done to solve it.

  • steve

    “we are purchasing our health insurance even if we get it as a
    benefit of employment because health care as a benefit exists in lieu
    of salary improvements”

    this is great

  • Sara Youner

    I do medical collections and the amount of wasted medical dollars trying to collect from insurance companies benefits the insureds have paid for is staggering. And they are clever, once we figure out how to get around one excuse, they stamp every claim with another. from “pre-existing, to “out of network” to “untimely” to coordination of benefits.

  • Jacqui Bennetts

    Suzanne, I feel for you folk in the states, I really do. The New Zealand system isn’t perfect but if I get sick I either get treated immidiately (if its serious) or get on a waiting list (if its not). Yes, we all know that some conditions which are painful or debilitating don’t ever get to the top of the pile, that is an issue we need to work on, but I have horrors when I read stories like yours. I read a blog called Brutal Women written by an american woman writer living with type one Diabeties. She writes very expressively on this topic in recent posts, her insurance company dropped all the employees at her company. Go have a look at what she went through, and in some earlier posts about getting what she was insured for delivered.

  • Sharon Martin

    No to Government run Health Care! I have seen first hand what happens when the government runs a program, it doesn’t work right! You think dealing with an insurance company is difficult, try it with the government! You’ll lose every time.I was always taught if I wanted something, I was the one that needed to work for it and not expect it to be handed to me. As with social security, Medicare and ALL other government programs, the programs ultimately become thought of as a “RIGHT”. All politicians know the system is heading for bankruptcy in a couple decades, but no one is rushing to fix it. Medicare is out of control. Fix what is broken now. With record debt levels already in place, we can’t afford to put in another “Untouchable” spending program. We must Stop spending!!

    • Suzanne

      I couldn’t agree with you less. The issue isn’t to arbitrarily stop spending, its to spend wisely. And actually the government does a lot of things right which is why we have a country that — with the exception of giving too much power to the rich who use it unwisely — runs really well. Try living in a third world country and then you can really see a government that doesn’t do anything right.
      I just wanted to post this comment I got from someone else

      You are one of the only people to post an objective view of the situation derived from a subjective experience. I too have been given the runaround by BC/BS and by Aetna and more than once. I’m sure I would have gotten the same treatment from Cigna had I ever been insured through them.

      ICD coding is so very important and, for a while in early times, facilities made the effort to hire well trained personnel to do the coding. Now since ICD-9 and later coupled with cost cutting many facilities require the MD to code his/her own procedures. One slipup, no pay. That is no pay by the insuror. You of course signed as the responsible party and the irresponsible party expects their money.

      You have very valid points. Some of us here feel the same way. Others simply spout the conservative rhetoric fed them by well paid talking heads who have no problem paying for ultrapremium health insurance. Good luck to you.

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