Health insurance doesn't always mean health care
08 05 08 - 20:24
Stealing remains illegal unless you happen to be a provider of health insurance whereby you can do pretty much whatever you want without explanation.
No other business would be able to sell a service then decide when, if, how and at what cost they provide that service.
The basic concept of health insurance would seem to be that you pay the insurance company every month and, in exchange for that cash, they cover the cost of your care should you fall ill.
Unfortunately, what actually happens is that you pay every month and then, if you get sick, someone who is not your doctor gets to decide if treating you makes fiscal sense.
One would assume that buying health insurance would mean that should your doctor want you to have a treatment, the insurer would be obligated to pay.
Of course, we all know that's not true as having health insurance only guarantees that it's possible the insurer might cough up the cash.
It's just as likely that they will refuse to pay or demand you follow a treatment plan different from the one your doctor wants.
If giving you the care or medicine you need fits in with their bottom line then you get it. If it doesn't, your doctor might be able to plead your case or he'll be forced to turn to whatever methods the insurance company will actually pay for.
Health insurance companies also get to change the rules whenever it suits them. Even though I have prescription drug coverage, that coverage actually only covers an ever-changing list of medicines that may or may not include what I need to take.
Since each insurance entity has its own list, no doctor could possibly know what he can safely prescribe to his patient without resulting in a denial of coverage.
My insurer has repeatedly refused to pay for the medicine my doctor thought would work best for me, resulting in my taking a number of second or third choice drugs.
Recently, however, I became the victim of an even more clever scam as two months into the calendar year my health insurance provider decided to drop my $250 prescription drug deductible and raised my co-pay.
They presented this as if they had somehow lowered costs for me without in any way acknowledging me, or the many like me, who had already met our deductible for the year.
Though I have already paid my $250, which previously would have met my obligation for the year and dropped my drug co-pay to $10, they decided I must now pay $15 each time I pick up a prescription.
This might be nice for people without any recurring prescriptions, but I, like many folks, take multiple maintenance drugs and pay off the deductible in the first month of the year.
This odd loophole enabled theft occurred because my insurance company issues plans on a calendar year basis but my company's plan gets renewed in March. This means we operate under the terms of the previous year for two months before new ones get imposed.
Using this quirk in the calendar to their own sneaky advantage allows the insurer two months to collect any money they want before deciding what deductibles to raise, lower, eliminate or make so confusing that fear stops people from going to the doctor anyway.
Clearly, the insurance company knew the change to my deductible was coming and, at least, they should have informed me before January.
Realistically, they should return a pro-rated portion of my $250 deductible subtracting the added $5 per prescription they now charge.
Since "fair" and "health insurance" go together as often as "politician" and "straight answer" I'm not exactly sitting by the mailbox waiting for my money.
While the aforementioned politicians pontificate about universal health care perhaps they should pay some attention to those of us who buy coverage but still lack coverage.
A clear schedule of fees, covered procedures and other rules should not be to much to ask and it does not seem unreasonable to expect to get health insurance when you pay for health insurance.
Columnisst Daniel B. Kline's new book, a collection of columns, Easy Answers to Every Problem, can be ordered at Amazon.com. Reach him at dan@notastep.com.