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September 27, 2005

And One Pill Will Make You Fucking Confused

Marketplace ran a story about the new Medicare prescription drug benefit plan for senior citizens that will start advertising in October and go into effect January. As with all plans that purport to use the private sector for public services, the touted benefit of the plan lies in the mythical power of consumer choice: choose what you like and let the companies compete for you (never mind that there is more power in being part of a group than in being a lone customer with nothing in the way of bargainning power). The angle presented on Marketplace emphasized the difficulty of choosing a plan. They played a clip of an insurance rep. explaining one of the plans which, incendentally, was explained to me by the H.R. rep. at the new employee orientation a few weeks ago (the particular scheme in question begins with a deductable; after the deducatble the insurance picks up a certain percent of cost until you hit the "roof," after which the insurance picks up none of the cost until another roof is hit and the insurance company pays either all or some percentage of costs thereafter). Then they played a clip in which another insurance rep. starts a conversation with two delightfully grumpy old men who croak at the young whippersnapper, "Are you selling insurance?" "Who is paying you?, eh?"

It was an interesting way to report the story, but I would take their line of skeptical inquiry a step or two further. Having just had the experience of having to pick a plan myself, I can testify that the unnecessary complexties of these plans are truly astounding. I'm a bright enough girl, and I couldn't make sense of it all. I'm sure there are plenty of people more confused than me. Which isn't even to get into the fact that if your government or employer is making you choose among different plans, they are basically admitting that none of the choices is wholly satisfactory in itself, that you are being asked to gamble on which deficienies will harm you least. Companies and governments, if they wanted to provide good coverage, would offer one plan they feel is comprehensive enough to cover everyone's needs.

It's not accidental that the choices are so ridiculously complicated and confusing. Health insurance policies profit off the confusion of policy holders. In the same way that cell phone/ computer/ electronic outfits profit enormously off of "free" deals that are free only after a mail-in rebate because a certain percentage of the customers loose their receipts, make a mistake filling out a form, or just plain forget to mail the rebate in, health insurance companies rake it in by confusing and/ or inconveniencing their policy holders so thoroughly that the consumer ends up footing much more of the bill than he or she should. I was a pained witness to this strategy at work when, last winter, Brett had to jump through hoops (and really, really small hoops very high up and enwreathed in flames, at that) to get the insurance to cover doctor's bills. Every time Brett called the insurance, he was given a new representative to speak to so that in all eleventy-hundred of the conversations he had with the company, he never spoke to the same individual twice (incidentally, this is a practice very similair in method to a practice called "cramming"that most phone companies use and is considered an unfair business practice. Phone companies routinely overbill-- most of the time the customer doesn't even notice-- and then make it near impossible to get the charges removed. They do this by making it so frustrating and inconveniest that most customers just give up. Listen to This American Life's story #253, The Middle of Nowhere). He was never told the last name of the person he was speaking to, even when Brett asked; one might guess this is to respect the privacy of the employee, but I don't think so. Not knowing the last name makes it impossible for the client to request to the same person again (phone companies have this policy, too). Needless to say, each new representetive Brett spoke to was unfamiliar with Brett's case and so had to be filled in by Brett, after which they would tell Brett to do things he had already done; he would tell them, and then he'd get transferred to speak with somebody else. It's very shrewd of them, really: the entire burden of explaining things rests on the shoulders of the patient while it is impossible to ever hold anyone at the insurance company responsible since you can't ever hold anyone to what they tell you.

The process dragged on for months, and at one point, his petition for partial reimbursement was flat-out denied. When he called to ask why (since earlier, a representative had explicitly told him to go ahead and pay out of pocket and he would be reimbursed), he was told that, somehow, a digit of his social security number had been entered wrongly into their system. Rather than correct their error, rather than calling Brett to verify his informatioin, they very deliberately chose to deny the petition instead. Brett hounded them, filled out more and still more forms until they finally aceeded, but it would have been no mark on Brett's credit and capabilities if he had thrown up his hands and given up. There is only so much a person can do. Especially (duh) a sick person.

Another, though less prologned, example of this kind of disingeniousness occured when I needed an abortion last winter. When I figured out I was pregnant (not all that difficult to verify: I missed my period, I got sick and weepy with hormones, my body felt sort of funny and wrong, and all the pee sticks showed two brilliant pink lines), I wanted to deal with it immedeately. I knew I wanted an abortion, so the quicker I could go to the gynecologist and have the procedure scheduled the better. Since it was obvious I was pregnant, I didn't bother to go to the Student Health clinic to pee in a cup, but instead went to see someone at the hospital right away. I was later told that because I had not checked in with my primary providor (the student clinic), the insurance would not cover the tab for the visit, lab and ultra-sound that totalled, if I remember correctly, just shy of $700. Whenever Brett or I would explain to someone on the phone that even if I'd peed in a dozen clincic cups I would have had to go to the hospital in any event since there aren't real doctors at the clinic, only NPs, and that the only thing that NPs do is administer pee tests, which I had already done, we were met with maddening repititions of a handful of lines that reflected a complete lack of absorption of anything we had just told them. The only way I was finally able to get a retroactive referral (at least two people told me that there was no such thing, which is patently untrue) was by going in towards the end of the day, crying and pitching a fit until I was permitted to speak with some heigher-up who, after I related my story, finally showed me some mercy. While annoying, the frustrations and stress of battling the insurance company did not prevent me from getting what I needed; I had the abortion and the insurance, however reluctant, did cough up the money. Not everybody, though, has the advantage of being a hysterical, demanding bitch from New York raised by two psychaitrists and therefore aware of the need to self-advocate in the medical system. They shouldn't be punished for a lack of bitchery. Why, if anything, they should be celebrated. Getting health insurance to cover what they are contractually obligated to should not require being a loud fucking bitch.

The fact that this plan is being unleashed onto senior citizens is especially concerning. It reeks of scam to me.

Posted by hissycat at September 27, 2005 09:41 AM

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