In 1999 and 2000, I spent about 18 months responding to collections calls on behalf of medical providers, gathering, sorting and re-sorting bills and receipts, and communicating by telephone, mail and email with my doctor's office, my law firm's administrator and the group insurance provider (United Healthcare or Blue Cross/Blue Shield--they blend together in my mind) over the denial of coverage on infertility treatments that were expressly covered and pre-cleared with the insurance company for up to a $35,000 lifetime benefit (my husband, my children and I will be forever grateful to the women who convinced the firm to provide that coverage!).
I couldn't just pay the bills and fight with the insurance company later because (i) I was broke after the birth of my twins (thanks again!); and (ii) I knew that if I paid the bills in the amount charged by the providers, without the reduction that the insurance company had negotiated, I would at most eventually be reimbursed only the discounted amount, which was a fraction of the provider's charges. After wasting countless hours of otherwise billable time (including hours during sleepless nights) that would have benefited the law firm that provided this important coverage, the insurance company finally sent a note of apology and paid the providers. Of course my credit rating had suffered, and I'll spare the details of consequential damages that I have written off to experience. When I began practicing as a self-employed attorney, I first paid excessive premiums to partially replicate the health coverage I had when I was employed by a firm, then dropped insurance for several years because the premium was far greater than my family's medical expenses, and finally settled on a $5,000 deductible policy realizing that with three children it might be imprudent not to have coverage in case of a major medical problem arising.
Recently, I read an article that convinced me that I pay close to full price at the pharmacy even with the card provided by my insurance company not because the insurance company is too incompetent to figure out that I will reach my deductible faster by paying the inflated amount for prescriptions, but because they actually receive a kickback from the drug companies when I pay that excessive rate, and that when and if I reach my deductible and they start paying it will be at the negotiated rate for the prescribed drugs. Do I have time to try to follow this through to figure out whether my suspicion is correct and then to try to take action to end this abusive practice? No, as the insurance companies are aware, no one has that kind of time until they are already receiving Medicare coverage.
Why is it not obvious to everyone that single-payer health care is the only way to rationalize the cost of health care? It is clear to me that medical providers could be paid more than the insurance companies are willing to pay and that the overall cost of health care in the US would be lower if the money that should go to paying our doctors and other providers generously and encouraging well-conceived preventive health care measures by both the medical providers and the public would cost less and benefit everyone.
As long as the abusive, monopolized industries (insurance, pharmaceutical, big agriculture, oil, service companies with connections to the administration, and now, banking and finance) continue to collaborate with government to fool the public with fear tactics and false rhetoric (socialized medicine; problems just like in Canada; caving in to our enemies; etc.) we will be puppets on strings, keeping our heads down and working hard to pay off our credit cards and make our mortgage payments while receiving the same or lower pay than we received ten to twenty years ago when we, briefly, enjoyed living closer to those earning in the top 5% annual incomes.
We have allowed ourselves to be corralled into a situation where we are duped into supporting the oppressors as they carefully tighten the web of control over our minds and our government. Maybe if I get the word out that I know what's happening they'll cut me in on the deal? It worked for Sarah Palin!
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