Some of you may have read my story detailing my foray into the wondrous pleasures of the free market to purchase health care insurance last summer. Well, I recently learned that those pleasures don’t end when the initial transaction is complete. Oh no no no no; as you’re about to learn, those pleasures only just begin at the first payment.
My story continues about a month after I purchased my policy, when, after seeking treatment for an acute condition that was causing me significant discomfort, I had the absolute insolence and temerity to file a claim with my new insurance company. Perhaps ironically, but most assuredly to my extreme misfortune, the treatment I received just happened to be for the same acute bacterial infection that prompted me to seek health insurance coverage in the first place back in January of 2009.
Now, as I detailed in my last story, when I applied for this insurance plan last August, the insurance company made me divulge my entire medical history. I did so, and, as I wrote, the insurance company agreed to cover me so long as I signed a policy rider that excluded me from coverage for all the conditions that, based on my medical history, I was even remotely likely to need treatment for during the rest of my natural life.
It’s important to note that on that application, I told them all about the infection I had in January. I gave them the name of the infection and the treatment I received. The policy rider I signed when I purchased my plan had nothing to do with my infection; it was about a chronic condition I’ve had since 2000.
Here’s what happened when I filed my September claim. First, the insurance company negotiated a lower rate with my provider. I thought that was really nice of them, until I realized that they were really acting in their own self-interest because I still paid the entire balance of the bill ($81—an important figure to keep in mind for later), which was applied to my deductible.
So, I paid the $81 for the office visit, and I figured that would be the end of it. I mean, after all, it was only $81.
But then the letters started arriving. "We need more info," my insurer told me. "Please fill out this form and list all the medical providers you’ve seen in the last five years that you may have not listed on your application."
I received three of these letters. The first two I ignored because there wasn’t anything I hadn’t told them. Then, on the third letter, I wrote down the name of a doctor that I had already told them about and sent it in. Once again, I thought that would be the end of it.
Then more letters came. "We have requested your medical records from the following provider," my insurer told me. I received two of these letters.
At this point, I thought I knew what they were up to. I figured they were going to try to get that $81 back from me, de-crediting it from my deductible. I thought they were going to claim that my infection was a pre-existing condition because I had suffered the same infection once before, which would make about as much sense as saying that if you had the flu at any previous point in your life then it counts as a pre-existing condition going forward. I knew it didn’t make any sense; I knew they were wrong, but that’s what I figured they would do.
Boy, did I underestimate them. I was completely wrong. As it turned out, not even my enthusiastic cynicism could guess the insidious, outright barbarous level of depravity at which these insurers operate.
Let me explain. This week, I received my final communication from the company. It came in one of those nice big flat envelopes so as not to damage or wrinkle the extremely important documents contained within.
Inside the envelope was a letter, two copies of another form (more on this soon), and an ominous return envelope, ominous because it was colored red.
The letter was from an officer at the company, and he informed me that, during their NSA-style investigation into my medical history, an investigation that couldn't have been more thorough if it were done under the spiked whip of Dick Cheney himself, they found something that I had not included on my application. Therefore, he wrote, he was including in his correspondence two copies of a retro-active coverage exclusion rider (naming the infection I had), which would exclude me from coverage not only on my current claim, but, indeed, forever. Furthermore, if I didn’t sign the exclusion rider and return it in the provided red envelope within five days, he promised to rescind my policy.
How could this happen? Well, you see, back in January, when I suffered through my ailment for the first time, the doctors who treated me did what doctors do: they put me through a series of tests in order to come to a diagnosis. As I’ve made known, they determined that the cause of my pain was a simple bacterial infection. After about a week of taking a common antibiotic, I was completely cured and asymptomatic until the infection struck again nine months later, which was when I returned to the doctor and filed the claim now in question.
Well, lo and behold, in addition to the actual cause of my pain (the infection), the doctors also found something that is very common among men and that most men don’t even know they have because it is completely painless and harmless, and it requires no treatment. Besides being in roughly the same anatomical area as my infection, the "other something" had completely no bearing on or relation to my infection. I was not treated for it, and it did not factor in my diagnosis. The test could have just as easily found that I had a cold, or a hangnail, or an unusually firm left buttock, or any other pathology completely unrelated to the condition for which I eventually received treatment. Of course, none of that mattered. What mattered to the insurance company (ahem, BLUE CROSS BLUE SHIELD OF ILLINOIS) was that I had something, anything that I didn’t include on my application.
Here’s what Blue Cross wrote to me: "Medical information [...] indicates that question #10 of Part Two, Section A: Health History, on your application dated August 15, 2009 should have been answered ‘Yes.’"
What is Question #10, you ask? Question #10, the last question on the application, basically asks, yes or no, whether I’ve had any treatment that I didn’t already admit to on the application.... Just let that sink in for a second and ponder what that question means....
Have you pondered? Because I’ve been pondering it for some time, and, as far as I can tell, the only discernible purpose of that question is to trick you into making a false statement. It asks applicants, yes or no, if they’re hiding anything. If you answer yes, then you’re a liar. If you answer no, like I did, then Blue Cross can spend as much time and money as it wants researching your medical history until it can find something that makes you look like a liar, which is what it tried to do to me.
But, as I’ve said, on my original application I specifically named the infection that I had! Why would I also list something that 1) I did not receive treatment for and that 2) had absolutely no relation whatsoever to the condition I did receive treatment for? The "other something" is neither a cause of the infection, and nor does it make one predisposed to recurring infections. The fact that I have this "other something" is as meaningless of a medical finding as the fact that I’m left handed. I answered "no" to question #10 because it was the truth! The question I’m left with is if Blue Cross was so worried about this infection, why didn’t they make me sign an exclusion rider for it in the first place?
As it happens, the smug, contemptible ass of an insurance officer (Boy, I'm sure glad there's no one between me and my health care!) anticipates that objection and takes up my question directly in his letter, writing,
While questions #3P and #4 were answered "Yes," and some details provided [Here he is referring to the part where I specifically name the infection], the medical information obtained indicates that there was material medical information pertaining to these questions that was not disclosed on the application [...] Based on a review of the medical documentation, it has been determined that had you disclosed this information to us at the time of the application, coverage would have been issued with a Coverage Exclusion Rider....
In other words, even though I told Blue Cross about my infection, they still feel it is completely within their discretion to, with the full benefit of hindsight, make comically absurd medical assumptions and determinations and then apply them retro-actively. So now my question is, what’s to stop Blue Cross from "determining" anything they want at any time? Why do they get the power to decide what constitutes "material medical information," especially after the fact? What’s to stop them from promising people coverage, signing them up, and then, when their clients need them, say, "oops," and pull out the rug from underneath them if it helps the company’s bottom line? The sad answer is, in my experience, nothing.
But that sad answer is also where we get to the really stupefying part. Blue Cross is so dedicated to finding ingenious ways to deny coverage to customers that they’d enthusiastically spend untold administrative resources over the course of several weeks to weasel out of my $81 claim and, just for good measure, make sure I never make a similar claim the rest of my life. Considering that my case is (thankfully) relatively meaningless, I can only think that it is sport for them. They’re just using me as practice for their really expensive claims, like those of Robin Beaton, who was initially denied treatment for breast cancer by Blue Cross of Texas because she had acne.
But even Blue Cross looks like an amateur when it comes to the unabashed, lewd exhibition of ruthless profiteering. To find the pedigree of this breed, you really have to turn to Aetna and their chairman and CEO Ron Williams, who casually announced over the weekend that Aetna plans to force up to 650,000 customers to drop their health insurance coverage. Why? Well, because even though they were rather profitable last year (Williams himself took home over $24 million), they just weren’t quite pulling in the numbers they’d hoped for. In an interview, Williams immodestly admits as much: "The pricing we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering," he said. I think Harry Reid described Aetna’s actions the best when he said, "...the company devised this strategy, crunched the numbers and saw how many American families it was going to hurt. Then the bosses shrugged their shoulders and decided to go ahead with it anyway." Usually when you give a whore like Aetna money, you expect some type of agreeable service or benefit in return. In their case, though, they take your money and then they screw you. I mean, we’re such suckers that, on average, the top five earning insurance companies, who averaged $1.56 billion in profits last year, spend 18% of our premiums on finding new ways to screw us. And, what’s even worse, is that they don’t just take our money, they enlist our help to screw ourselves on their behalf!
And yet, this type of for-profit health insurance system, this system where the people’s health is in every sense at odds with the interests of the companies supposed to protect it, is not only allowed to endure and thrive in this country, it is actively defended by senators and representatives bought and paid for by the health insurance lobby. If people’s lives weren’t literally at stake, the transparency of it all would be comical. Instead, it’s just shameful. Really, its patent baseness is mind-boggling.
And that blatantly obvious way in which these insurance companies and their paid shills in Washington go about their business is why it is nearly impossible for me to wrap my mind around how these idiotic doomsday narratives of a "government take-over" of health care not only persist, but manage to control the debate when every piece of evidence—not just research (by that I mean reading a newspaper), but the evidence that piles up just by personally enduring the system—points to the fact that a private, for-profit health insurance system provides absolutely zero public benefit and is in fact the most ill-designed system in the entire civilized world.
Thankfully for me, my experience has been extremely mild compared to those of many others (1, 2). However, my experience does no less to lay bare the miseries and misplaced incentives of America’s health care system. Indeed, the pathetically low stakes of my claim juxtaposed with the desperate response it instigated just further uncloaks the insurance companies as the money-lusting, unscrupulous, blind opportunists they truly are.