My health insurance company does nothing for me except waste time

I pay $600 a month for health insurance that doesn’t cover the procedures my doctors ask for, and then even makes it difficult for me to pay for them out of my own pocket. A company that would rather have me on the phone taking up their representatives time for three hours than just answer a simple question.

This is literally insane. They not only don’t provide the service I pay for, they get in the way of me paying for those necessary services myself. In no way does this make sense, or is it a useful, efficient way to run health care.

Here’s my story:

My ear nose throat doctor (who cost me $500 for one visit after insurance) wanted me to get an MRI of my sinuses, which have always been a problem for me. I'm having trouble smelling and of course he wants to know if it's a tumor or just bad genes. I'm voting for bad genes, but at some point you have to stop guessing and make sure, just in case it’s nothing serious, like a lemon sized lump in your noggin.

It takes the doctor two weeks to get an authorization (though a third-party company whose sole job is to get authorizations through insurance companies since it's clearly so hard). I get a letter saying I’m authorized, but I know better than to rush into getting the procedure, because I need to know how much this approved procedure will cost.

I call the insurance company to find out the co-pay. How much will this covered procedure cost me?"

"We can't tell you," they tell me, like that’s a good answer.

WTF? I think but don’t actually say. “Why not?” I ask, politely.

"We don't know, it depends on your policy and provider."

Well, you know my policy and here's the doctor's name.

"We still don't know. What I can tell is that we won't cover it."

WTF redux.

"You haven't met your "out of pocket" expenses."

No, I only pay $600 a month for which I get TWO doctor visits a year (that's it, just two!) and yet I haven't spent another $3,500 of my own money to pay for what they should be paying for out of the $7,200 a year I've been paying them for years--out of which I've gotten $2,600 worth of service (I know, because they do manage to keep track of that!)

It's a great deal, right? $7,600 a year for at least five years, $38,000 to get $2,600. Wow, what a value. And--even after paying them all that, they still won't cover a prescribed and approved procedure.

But--and this is great--I can get it at their contracted price! Whopee! Why am I happy? Because insurance companies usually pay less for service than individual human beings without unlimited profits do.

A few years ago I had a colonoscopy when I had no insurance. It cost me $5,000, which is when I realized I had to have insurance, because the insurance company would have paid $1,200 but the uninsured get to pay $5,000.

(Note, I've had a colonoscopy since getting insurance and and it still managed to cost me $1,500, even though according to Marin General hospital, the insurance company only paid them $1,200, so in reality insurance didn't cover anything at all, in fact, the insurance company seems to have made $300 from my procedure rather than paying me anything--and they still chalk it up to my lifetime limit of what they’ll give me!)

So now how much is their contracted price? They won't tell me. Part of their contract says that they protect doctors from the patients knowing what something really costs.

AH! Of course! Because otherwise I might know how much more I’m paying than they pay. The only reason I knew what they paid for a colonoscopy is because when I balked at $5,000 (since I was told $2,500 in advance), the hospital finance person told me that insurance would pay them $1,200 and I said, “I’ll pay that,” and she said, “We won’t accept that from you, only an insurance company.).

Oh.

I call the doctor. They don't know the price, either, it depends on the policy. Call your insurance company. Thanks.

An hour or so later of phone time (which costs the insurance company money--money they don't spend on care), I'm told I have to find out the tax ID and CTP code from my doctor. I call, and get it. Call the insurance company, go through the menus (I've memorized them, #4, my SS#, #2,#0 - waiting between each step), and give them the info and they say they'll get back to me--in a week. It takes them a week?

OK, so can they tell me? Which means they aren’t protecting the contracted price at all, which means none of this makes any sense and is just a gigantic waste of time designed to get people to simply stop bothering them.

Except they never do. I hear nothing from them. I do get an email saying I have an important confidential email in my secure email section of my online account. Well, I’ve been using the web since 1995, when it became public. I had one of the first sites on the web. I’ve worked with IBM on information design. And I could not find this magical secure email section. It’s not listed on the site at all after I log in. I try every single solitary link, even one that makes no sense to take me to WebMD or something, and there I see a link to a secure email box.

Why there couldn’t be a link in the main area is a mystery, except it seems to be part of the “let’s make it as hard as possible to do anything so they’ll give up and stop bothering us, other than to send us a check every month,” ethos.

That email turns out to be reminding me it’s time to have a physical, which I already got, on my own dime, because I didn’t want a routine office visit to count as one of my two doctor’s visits for the year, which somehow it ended up counting as anyway, meaning that they paid for an $120 visit instead of a $500 visit to a specialist.

Everything is clearly designed to simply make you the insured patient just give up. After a while it’s not worth the time or effort to get a fucking MRI that your doctor said you should have. Who the fuck cares what’s going on in my head other than the hold music of the Health Insurance call center.

Today I decide to call them back and try again. 45 minutes on the phone--they never called because the approved facility is no longer under a Health Net contract. Really? First, they couldn’t tell me this? Next--The company that does approvals didn’t know that when it’s their entire job? (They told me they get their database from the health insurance company).

I call the MRI company, get the Tax ID and CTP numbers again--they are the same.

800-blah-blah-blah, 4, ss#, 2, 0 wait... give them that information, and gee, it’s the same. That facility hasn’t been in their system since Feb 2008. Interestingly, the facility says they take my insurance, and the pre-approval company says they do, too, only the insurance company says they don’t! And it’s pre-approved, remember.

So finally, after another 45 minutes, I ask if there’s an approved facility, and she gives me another facility in my area, and will have the research department that never contacted me before contact me this time with the price. If the doc’s office would call they could find out today--but they already told me they won’t do it because it takes them a half hour and its a waste of their time--which it clearly as, just as it’s a waste of my time and the insurance company’s operator (and in this case supervisor, because she has to keep asking her, too).

BUT--first I have to now get it all approved all over again, because it’s a different facility. Same approved procedure--which will take weeks, and which, remember, the insurance company is not paying for. But in order for me to get the contracted price, it all has to be pre-approved again.

So I call the pre-approval company, MedSolutions, and they say they can make the change instantly online, it doesn’t need another approval, and they do. It’s the same procedure, it’s my legal right to have it done anywhere I want--except the insurance company never told me this--even though they’re not paying!!!

And how much will it cost? The nice woman at the pre-approver (the nicest person I’ve talked to) suggests I just call the facility and ask. I say, “I’ll try, but the other one didn’t know).

So I call the facility, Bay Area Open MRI, and yet another perky chipper nice person (Julie) answers. She knows the contracted price (how is that possible, given that nobody else does?) It’s $800. But wait--they have a special for the uninsured or those who don’t want to run it through their insurance. OK, I wait for it--since the uninsured always pay more than insurance companies who can afford to pay more.

The special price is $600.

WTFx3?

It’s the first time I’ve ever heard of an individual being charged less than an insurance company, but it probably is so much less trouble for the MRI company, and so many people are uninsured--or worse--unable to use their insurance because it won’t cover it, or get approval, or simply even return a call or an email, that I guess whoever runs this place is smart and figures that in this economy offering a 25% discount make sense (in the retail world, 15% discounts across the board are now standard--to start).

So, in the end, three hours of phone hassle is actually going to save me $200, which, amazingly, makes it a good use of my time. Of course, the insurance company could have just told me, “Here’s a place you can get it for $600” to start with, but I’m sure their contracts with doctors prohibit giving patients the best deal. Or, the insurance company could have paid for a necessary procedure, which, I used to think, is what I'm paying them $7,200 a year to do.

Now, the question is--why do Americans have to suffer through a terribly wasteful and stupid system like this? Hopefully it will be changing, but there are still many Americans who are afraid of this change. Afraid the big bad government will keep us from getting the health care we need--the way that the big bad insurance companies are already doing now.

Except with government involvement there will be caps on what we have to pay, instead of the current outrageous mortgage-sized premiums. And then we won’t be able to get canceled if we get sick (unlike now, where you can be canceled at any time, no matter how much you’ve paid--which is why I’m not naming my health insurance company here!). And then you will also be able to get insurance if you have a pre-existing condition, whereas now you simply cannot unless your employer offers it or you can pay a premium that’s higher than your mortgage (the entertainment industry insurance alliance used to be great--now it costs $1,400 a month--a month, which is a dirty trick so that the insurance companies can say, "See, we offer insurance to people with pre-existing conditions!" but they do it at such an outrageous price it's literally impossible for 99% of people to afford!

Anyone who cares about their health, and the health of their loved ones needs to support health care reform. Because even if you are afraid of the government in your health care--at least then you'll have some kind of vote on it. Now you have no say--except to not have insurance, which if so financially dangerous you can’t do it.

So give yourself a vote on health care and costs. Let the government do what good governments do--help you. That’s what they’re meant to do. That’s what they do in Canada, UK, France, Germany, Sweden, The Netherlands, Holland, Spain, Italy, Japan, Australia, New Zealand and countless other civilized free democracies. If they can do it, surely we can, too, right? Because anything they can do we can do better? Let's prove it, at long last.