This Is Why People Hate Health Insurance Companies

For many people, health insurance premiums take a sizable bite out of their paychecks. Which would be somewhat tolerable if insurance companies did anything to ease the process of actually receiving medical care. Heck, most of us would tolerate the pricey payments if insurers just did the bare minimum of what they are supposed to do and didn’t put up roadblocks to getting the proper care. And yet that simple concept appears to be too complicated for some insurance providers to grasp.

Take this story from David Lazarus’ column in the L.A. Times about a father who has spent a year and a half dealing with nearly incomprehensible levels of idiocy at Aetna, as the insurance company repeatedly tried to force his daughter to get care at a clinic that doesn’t provide the care she needs.

The father in the Times story has a daughter with autism. He also has an Aetna policy that is supposed to cover 20 visits a year to the occupational therapy his daughter’s doctor prescribed in Feb. 2011, so long as the therapy is provided at an in-network clinic.

Aetna signed off on therapy at a nearby clinic, but then the father discovers that this clinic does not provide the specific treatment prescribed by his daughter’s neurologist.

Thus he went back to Aetna for the name of another clinic.

Aetna told him to go back to the clinic.

The father wrote Aetna a letter trying to explain what they had obviously ignored — that this clinic is not the correct one for his daughter.

Aetna once again told him to take his daughter to that first clinic, where she won’t get the care she needs.

It gets better/worse (depending on your tolerance for repetition).

The father went back to the clinic. He got a letter from the doctors there explaining that they could not help the young girl. He asked Aetna once again for a new referral.

And he got one. To the same exact clinic.

The father, who subsequently went out of pocket to the tune of $120/session for an out-of-network clinic that could provide the therapy his daughter needs, filed a complaint with the California Dept. of Managed Care, since state law now requires insurance providers to cover prescribed occupational therapy for children with autism.

In order to legally dispute the issue — and per the terms of his Aetna policy — he filed for arbitration with the American Arbitration Association. When the arbitrators made the standard request for Aetna to waive the provision of its contract limiting the amount of damages that can be awarded to customers, the insurance company didn’t respond. This bought the arbitration process to a halt.

But investigators for the state didn’t look so kindly on the insurance company, saying that Aetna had “either ignored or disregarded” the father’s attempts to correctly follow the company’s own referral procedures. The state found that Aetna had made no attempt determine whether the original in-network clinic could provide the prescribed therapy.

The state ordered Aetna to pay for the father’s out-of-pocket expenses and to continue paying for treatments at this second clinic through 2012.

A rep for Aetna tells Lazarus that — in spite of multiple attempts by the father to clearly point out that the first clinic could not help his daughter — the insurer “originally did not understand the nature of the dispute.”

The rep also tried to point the Flaming Arrow of Blame (patent pending) at the father, telling Lazarus that the dad must not have followed the referral process correctly. Yeah… state officials have already deemed that claim “factually inaccurate.”

In many ways, Aetna’s insistence on the original clinic is not very different than some phone CSR for a cable company telling you to reset your modem for the fifth time while you’re trying to explain to them that there’s a severed cable dangling in your backyard.

But while you can always cancel your cable — you’ll survive without the History Channel — most people have no such options with their insurance provider. Cutting cable out of your life will only put more money in your pocket; getting rid of your health insurance only serves to make treatment more expensive, and all but guarantees you won’t receive the level of care you would if you had coverage.

Insurance companies may not be required to pretend they care about our well-being, but they are required to do their jobs correctly. For the money Aetna and other insurers make, it’s not asking too much.

One battle in the war against health-insurer insensitivity [L.A. Times]

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  1. sir_eccles says:

    Insurance companies are businesses that are beholden to their shareholders to make profit. That they enable access to healthcare is an annoying little side business that ruins profits.

    • TuxthePenguin says:

      Its not that its a for-profit venture, its that it knows the consumer has little-to-no power to harm its actual customer – his employer. Bad things happen when the consumer is not the customer – so long as your customer is happy, the consumers can do whatever they like.

      That’s the real problem. Figure a system in this country where the individual/family purchases their own health insurance and is somehow mobile, a lot of this stuff solves itself. But until the consumer can strike at the bottom line by losing the company customers, nothing will change.

      • HalOfBorg says:

        I’s not hard to ‘figure a system’ – just let people buy their health insurance from whatever company they want, regardless of where that company is located – just like all the other insurances (which do not seem to be having any problem). Now, instead of MAYBE 2 choices through work (for the lucky ones) they have a host of choices, all competing for their business. This would improve a lot of things.

        • Deep Cover says:

          It’s not that “simple”. Insurance companies are regulated LOCALLY. There is no insurance company that is well versed in every state medical regulation. Put quite simply, you can’t buy insurance in Alabama and expect it to pay for hospital coverage in California. This is NOT the same as a car where the price for a Ford F150 is the same in Mobile as it is in LA.

          • sir_eccles says:

            Plus moving from a group policy to a private policy opens up a whole host of issues.

          • Captain Spock says:

            I am not sure how my Insurance works then…

            I have Empire BCBS which is regulated out of New York I believe..

            I live in Chicago, although I do work for a New York based company,

  2. Zanorfes says:

    Flaming Arrow of Blame – nice. Should be used more often, just like “grocery shrink ray” which is a regular on Consumerist columns. By the way, all insurance companies are evil entities that suck.

  3. dragonfire81 says:

    But Obamacare and Universal health care are just ridiculous communist evils right?

    I get so flustered debating health care with people in this country. I happen to come from a country (Canada) that HAS universal care (I miss it, believe me) and unless you’ve lived in one, you DON’T KNOW what it’s like.

    Fox News and the like have done a phenomenal job of convincing everybody that universal care is just an awful, terrible horrible thing that no true capitalist nation really needs.

    Newsflash: The U.S. spends MORE PER CAPITA on health care than any other country in the world, which of course includes many that have Universal care. Don’t try and tell me the system we have now is more affordable.

    I’m not saying single payer is perfect. Believe me it isn’t. There are exclusions, there are wait times and there are certain procedures and treatments that aren’t easy to get but given the choice between the American system and Canadian system I’d take the Canadian any day of the week.

    It may not be perfect, but it doesn’t have pre-existing condition nonsense nor will you go bankrupt on medical bills easily.

    • oatmealpacket says:

      Alright, America, it’s time to wise up and listen.

      Listen to this man with a Mega Man avatar.

      (Or Rockman if you weren’t all such sheeple! Fox News has ruined everything!)

    • AtlantaCPA says:

      As long as the republican party (and probably lots of democrats too) get campaign donations from insurance companies, there will be no vote to enact universal health care. I wish that it would happen one day, but sadly I don’t think it will be in anyone’s lifetime who is currently alive.

    • Tedicles says:

      ‘I’d take the Canadian any day of the week’

      But isn’t that the point EXACTLY!?!?!? Go for it, choose anything you want. But do not choose for me, maybe I am perfectly happy with what I got and would like to choose something different. Problem is not coverage, rules, regulations, etc….it is about freedom of choice for the individual. When others dictate what insurance I should have (or lack thereof), THAT is communism.

      And yes, I also come from a country with socialized health care, and if my grandmother/grandfather/aunt/etc had also moved to the USA they may have been alive today thanks to treatment they were denied!

      • AjariBonten says:

        well, you do make some very good points. However, the reality of the situation is that we DON’T have a choice in what sort of health insurance we have, or the provider thereof. That choice truly resides with the employer. And the expected reply of “well,you can choose a different employer” won’t cut it. That is RARELY an option, if ever.

        • AjariBonten says:

          “” When others dictate what insurance I should have (or lack thereof), THAT is communism. “”

          Others ARE dictating that decision.

          • Tedicles says:

            Those others are choosing what you receive as compensation. That is very different from not allowing a private person to choose: 1. whether they want insurance and 2. what insurance company they would like to receive said benefits from. I never meant everyone should have infinite choices across the board; but be allowed to choose for themselves if they can/want to do so.

            What would have been a better step towards a comprehensive solution is to allow insurance coverage to cross state lines in order to allow more competition. Then the employer may very well be able to offer more choices.

        • Pre-Existing Condition says:

          I agree, the lack of choice is the problem. We have a market system without any of the advantages of a market system. There’s essentially a 20% or more tax penalty for buying a policy outside of a group plan. It’s ridiculous.

        • Kuri says:

          Well, the choice either resides with your employer or the size of your bank account.

      • AstroPig7 says:

        The “I’ve got mine, so why should I care about everyone else” attitude is possibly the largest barrier to curing many of our social problems. As for your ancestors, whose situations I am not trying to make light of, wouldn’t that apply only if they could afford the coverage and weren’t denied on a technicality?

        • PsiCop says:

          Re: “The ‘I’ve got mine, so why should I care about everyone else’ attitude is possibly the largest barrier to curing many of our social problems.”

          This is true. People with healthcare coverage fear they’ll lose healthcare access if it’s granted to people currently without coverage. In other words, it’s a zero-sum game, and they need to prevent others from getting coverage, in order to maintain their own. That it doesn’t work that way doesn’t seem to mean anything to them.

          They’re the folks who cheered Ron Paul when he said he wanted uninsured patients to die.

          But at the same time, they — and their standard-bearer Ron Paul — seem to forget this salient fact: The uninsured are ALREADY getting healthcare, and YOU are ALREADY paying for it! It comes in the form of cost-passing, specifically in increased hospital & provider charges for those who do pay their bills, to make up for those who don’t. And it comes in the form of so-called “hospital taxes,” levies of up to 40+% on hospital bills that states collect in order to fund indigent care that they end up having to write checks for.

          The idea that we can keep from having to pay for healthcare for “slackers” and “welfare queens” and so on, is a fallacy. In truth, that ship has already sailed … we ARE paying for their healthcare. Rolling back “Obamacare” is NOT going to prevent it, because it’s already occurring.

          The reality of the situation is that it would be MUCH more efficient and cost-effective if all of these people whose bills are currently being paid from OUTSIDE the health-insurance system, were instead INSIDE of it, were paying insurance premiums (even with the help of government subsidies), and then had their bills paid by insurers afterward.

          Then there are the people who say, “I don’t want government bureaucrats deciding how I’m getting treated.” Yet they don’t mind “corporate bureaucrats” making exactly the same decisions. As far as I’m concerned, the two aren’t any different. One bureaucrat is as bad as any other.

      • Bunnies Attack! says:

        Wait, that doesn’t make sense. When people seem to think that they would get health care in the US that they were denied in a socialized health care system, they need to take a step back and realize that they probably would have been denied in the US system too. In the US system, the insurance bureaucrats are incentivized to deny coverage as much as possible, what makes you think that they would have received coverage in the US that wasn’t available elsewhere? It makes no sense.

        • Tedicles says:

          Ok, fair enough from your pov, but this was not the real-life experience. My grandmother, for example, was summarily denied treatment which would have extended her life and improved her quality of life. But, that treatment was denied to her, and was told very frankly that “it would be too expensive considering her age, and those procedures (and associated costs) are reserved for younger people.” Under the coverage we had at the time in the USA, she would have been covered and received treatment. Aside from whatever insurance we had at the time, at least it would have given us the option to seek treatment outside of the insurance coverage.

          It should also be noted that under the socialized system she was never able to see the same doctor twice, made to spend countless hours at the hospital each time she went and generally ignored by the system until she ‘went away.’

          Would it have been possible to get her to travel to the USA for treatment at our own cost? Probably, but hindsight is 20-20 unfortunately and I/We were not directly involved in her daily treatment back home (plus she was deathly afraid of ever visiting the USA again due to our pleasant immigration/customs officers who had last time decided to detain this wheel-chair bound woman who could speak no English for several hours of interrogation).

          This is not so much to argue one system over the other, but to try to explain that in theory it is great, but does not work in practice. This has been my personal experience (and that of countless friends and family from Scandinavia).

          • VintageLydia says:

            But how do you know that it would’ve been covered here?I mean, you could’ve paid for it out of pocket here, but in some countries that have socialized medicine that is also true (Australia comes to mind.) Insurance companies deny treatment all the time for weird arbitrary reasons and one of the most common is “the cost isn’t worth the result” which was the basis of your grandmother’s denial (true or not.)

            • Tedicles says:

              After finding out all the facts, we checked our own coverage (here in the USA) and it would have been covered, regardless of age group. This was about 12 years ago. Others with the same conditions, but younger, were given the treatment in Scandinavia.

              • Bunnies Attack! says:

                I understand your point of view and yes, its all conjecture because we can’t see into the future or alternate realities to see all the “what-ifs”… but you hit the nail on the head there. In scandinavia, it was determined that she had lived a full life and it was better to save this 20 year old than this 70 year old… the net benefit to society was considered. In the US, the poor person would have died.

              • VintageLydia says:

                But that’s YOUR coverage. She would not have been able to be added to your plan. How do you know the insurance she could have gotten on her own would have covered it?

      • Chuft-Captain says:

        News flash: Others are already dictating what sort of insurance you should have, due to the severe limits on what options you can get. Also, you seem to have a serious misunderstanding of what communism means.

        • euph_22 says:

          And instead of limiting care based on the fundamentally limited healthcare resources available, and reducing costs for citizens, they are limiting care to increase their profits.

      • ARP3 says:

        1) You don’t understand communism. Now, if the government owned all factories, private business, etc. and were all government employees that would be communism. Unless you’re implying that all first world countries (except the US) are communist.
        2) You already have a lack of choice
        3) We engage in “communist” activities on a regular basis to provide police, fire, roads, libraries, infrastructure, even though at times we may use it more or less than others.
        4a) What country are you from that the socialized health care was so bad.
        4b) Did your family have enough money to afford the supposedly superior care the US provides. It’s easy to say its available, but you need to be able to afford it.

        • Tedicles says:

          Wow….real discussion and debate without resorting to crass insults–cheers to all… :)

          1. There are varying degrees and different doctrines within communism. I was referencing communism in more the conversational setting, where we give more and more of our choices up to a centralized government or ruling party (yes, more akin to socialism). China is still ‘communist’ but there you can own property today.
          2. Agreed, but less is not better. We need MORE choices.
          3. No, not really the same thing. Please study communism a bit more. To share costs for shared services as a community does not communism make.
          4a. Sweden
          4b. Insurance was actually European based (I know, ironic, but a long story) here in the USA. Cost was not like USA ‘cadillac’ plans, but on par with private health insurance in the USA (but we received coverage worldwide which made it more appealing)

          • richcreamerybutter says:

            We do need more choices. I would love the choice to opt into a single payer system, but private insurers have admitted they wouldn’t be able to compete with a government-run plan. This contradicts both “freedom” and “free markets.”

            And with all due respect to your grandmother, are you sure she wouldn’t have been denied due to a preexisting condition or would have been otherwise eligible to be added to the policy? You mention the treatments would have been covered, but would insurance company bean counters have even given her the chance?

      • zz9 says:

        Then live in the UK. We have the NHS, universal healthcare for everyone with no paperwork etc
        OR you can choose to buy private health insurance. Which despite being cheaper than health insurance in the US (because they don’t have to cover ER, ambulances etc) not many people choose to buy. Reason? They’d very happy with the NHS. That is choice. Americans do not have that choice.
        I can go see a doctor without having to even consider any financial implications. I don’t have to worry about losing health cover if I lose my job, or change jobs or start my own business.
        For every “horror story” Fox News come out with of people denied care or badly treated there are a dozen cases like the woman charged $80,000 for two injections (that cost $100 each in Mexico) or the lifeguard charged $1500 because he rode in the ambulance taking a kid he saved to ER.

        • BurtReynolds says:

          Yup. I remember being uninsured after college and having a pain all over the left side of my body. Who knows what it was. I sat around for hours trying to decide if it should go to a doctor. I wasn’t even worried about the ridiculous cost of a visit, but rather the idea that I could be identifying a pre-existing condition for when I did get a job. I never went and luckily it didn’t seem to cause any problems.

          I now have what the woman at the ER called good insurance. I went to the ER for the first time in my adult life a couple months ago. I had a minor procedure done, received IV fluids and they ran some tests. Even with this good insurance it cost me about $450. A lot of people wouldn’t be able to afford that.

      • Kuri says:

        And then their insurance company would have found another reason to deny them a procedure, such as it being experimental.

      • BrettB says:

        When you give up the right to care that you cannot afford, I’ll happily give up the requirement for you to insure yourself in the absence of universal healthcare.

        What do you call it when I have to pay for that care you can’t afford? Care that’s likely to be in the most expensive and least efficient and efficacious setting? Add in my costs for healthcare related bankruptcies and the cost of disability and survivor benefits when your care is substandard or you go without care. On the communism scale, I think this handily beats the individual mandate.

    • luxosaucer13 says:

      Agreed. I’d like to point out to all the critics of government-run programs that it’s about time we give single-payer healthcare a chance here in the US. What we have isn’t run by the government at all; it’s run by the PRIVATE SECTOR, the very same folks that critics of the government want to entrust the nation’s Social Security needs to, and they’ve screwed health care up so completely in this country. I can’t imagine single-payer being any worse than what we have now.

      • Bsamm09 says:

        You would rather keep social security the way it is? I would rather have that money in a private account like my IRA.

        • Chuft-Captain says:

          Yeah but that is not what they have been trying to do. I, too, would much rather have my mandated withdrawls placed into an account that I control, but they want to take it all and invest it as a whole, with no control by you.

        • who? says:

          I’m an upper middle class, educated person, who is nearing retirement. I’ve been saving and investing my entire adult life, and social security will be a minimal part of my retirement. I would prefer that social security stay the way it is. Why? Because Social Security wasn’t designed for me. Social security was designed as a plan to keep the elderly out of poverty. Before social security, people didn’t retire. They worked until they couldn’t work anymore. Back then, just like today, people who were just getting by weren’t capable of saving for retirement on their own, and once they couldn’t work anymore, they fell into poverty. As the anti-poverty mechanism it was designed to be, social security has been wildly successful.

          This whole “I got mine, now you go away” mentality that a large portion of our country has developed makes me ill.

          • RandomHookup says:

            Back before SS, a retirement program was known as “having lots of kids”.

            • Kuri says:

              That or it was “hope you die at the assembly line”

            • Bodger says:

              Consider that the longest lived group in the country, white females, had a life expectancy of 63.5 years when Social Security came into effect. The simple reason that 65 was set as the official retirement age was that not many people were living that long back then. BTW, today the number for that same group is 81.3 years. That says a lot about why SS is in the financial shape it is.

          • Bsamm09 says:

            According to the social security website, the average monthly SS payment is $1,230 which is $14,760/yr. Assume you live 20 years after you retire at 66. That is roughly $300,000 you need at retirement.

            If you start working at 20 and make $25,000/year each year until you are 66 and the Social Security tax paid by you and your employer ~10% is deposited in a private retirement account that you cannot touch you will have roughly the same amount if you average a 4% return a year.

            But it is your own money. If you die the day after you retire you can leave the entire amount to your family.

            It will be hard to transition the system and I doubt it would ever happen. The gov’t loves that money. They play around with it a lot (Which is a problem).

            • who? says:

              This is all fine, and I don’t have a problem with it. Except for two things. First, most people aren’t as good at investing as you or I are. I wouldn’t expect them to be. Remember, this is a program to keep people out of poverty, and I don’t expect someone who spent their life working on a construction site to need or want to know about mutual funds, expense ratios, or inflation risk. Second, social security, in addition to providing a pension for the elderly, also provides disability payments and survivors benefits to people who haven’t managed to work long enough to have saved all that money yet. We still need a way of taking care of those people.

        • RandomHookup says:

          Social Security is really an insurance system. We don’t “own” that money that we pay in. If you need to draw it out early because of disability, that’s fine. You’ll get more out of the system than you paid in. Die early and don’t get your money out, sorry about that.

          I prefer to have at least one system in place that allows people to be stupid and still get something out of it. Too many defined benefit programs have been converted to 401k and employees given control of their money which they end up blowing because they can’t plan or foresee that they will actually need that money in retirement. And I certainly don’t want a set aside account tied to the stock market where I can watch my assets take a nosedive once again.

          • adlauren says:

            “Too many defined benefit programs have been converted to 401k and employees given control of their money which they end up blowing because they can’t plan or foresee that they will actually need that money in retirement.”

            It sounds like you’re saying that retirement is something that people aren’t smart enough to handle on their own. Where’s the line though?

            Health care: you aren’t smart enough. Gambling away your money: you are smart enough. Retirement: you aren’t smart enough. Credit cards: you are smart enough. Should there be insurance systems for every possible way that someone could lose money?

            • RandomHookup says:

              Not every one, but enough so that people aren’t left with nothing. This one program should be a pretty good place to draw the line.

        • luxosaucer13 says:

          The problem with taking Social Security private, 401k-style, is what if the people deciding which avenues to invest in make the wrong choices and the stock market crashes? There goes the Nation’s collective retirement plan…..*poof*, disappearing like magic. What then? What do we tell the Nation’s senior citizens who depend on that money? Tough toenails?? “Oopsie….well, we TRIED to make it better,” just wouldn’t cut it! Too much risk is involved in the stock market and I’m not comfortable with what little safety net I would have with Social Security being gambled with in that matter. If I wanted that kind of risk, I’d take it out of SS and go down to my local Native American casino!

    • SpeakR40Dead says:

      I see your point.

      But if the US had true universal health care, where would all the people go who currently COME TO the U.S. for procedures BECAUSE of exclusions and wait times in their own countries?

    • cspschofield says:

      OK, let me see if I can make my case to you.

      In this instance the Father may well eventually get some degree of service from his insurer because the government stepped in and ruled against the insurer. The closer the insurer and the government are to sleeping in the same bed, the less often this will happen.

    • kcvaliant says:

      Question? I do not know, what percent of canadians do not pay taxes?

      I do not blame all the working folk now not wanting obama care. Obamacare is not going after the main problem, cost for everyone.

      Now: it works that you pay more then you should for all the uninsured workers.
      Obamacare: will force already lower class people to lose jobs, because businesses will be required to get insurance or fines. They will layoff workers and put the costs on the ones remaining. The uninsured will still get their free medical visits. More people unemployeed, less workers, increase of costs on medical care from he uninsured.

      Sorry, but it is a bad idea, great in a hypothetical world where mankind is in it for betterment. But the problem is the bottom 47%, the obamaclass of citizens, you need to find a way to get them off entitlement. So far, no canidate has a plan for that,just bandaides for a gushing hemorage.

      • Chuft-Captain says:

        Wow, you really swallowed that crap about the people not paying taxes hook, line, and sinker, didn’t you? Why don’t you do a tiny, tiny bit of research – about three seconds of typing in the Google search page – and see what is actually included in that “obamaclass”.

        Hint: It includes students who will become producing taxpayers, the low-income elderly, and the unemployed. And almost all of that “half” or so who “don’t pay taxes” do, in fact, pay taxes – sales tax, state taxes, etc.

    • kanenas says:

      If Canada’s system is so great, why are you not in Canada?

  4. Hartwig says:

    All Aetna had to do here was accept blame and say some nonsense about CSR training and this whole thing would have made them look halfway decent. Instead after a state investigation they still claim that it was the parents fault. I don’t know why it’s so hard for companies to just say “I am sorry we made a mistake and we will learn from it”.

    • SpeakR40Dead says:

      It could be their way of ‘saving face’ to their stockholders. (Screw the public, they NEED healthcare, we need happy stockholders)

  5. SpeakR40Dead says:

    The sad fact is that like cable companies, you deal with people with limited capabilities. First off, having used aetna for the last 5 years, I have always looked up online where to get specific treatment and if they had bad service, I’d find another one that was covered by aetna. All they specify is that the facility (and sometimes the doctors) need to be ‘in-network’.

    They can’t stop you from using a different clinic all he had to do was go online to find one ‘in-network’. But in the end, aetna messed up big and in my opinion got off easy.

  6. Charles Edward Winthrop III, Esquire, Investigator of the Unknown Music says:

    Every December when my insurance renewal comes up, I get a letter from Aetna “welcoming” me to their network, along with a list of all the doctors “in my area” that are in-network (nearest is 350 miles away). And every year I have to go through the same rigamarole of calling them up saying I didn’t sign up with them (they claim it’s “automatic” and can’t be stopped), and then call my regular insurance provider and get them to sign me back up.

    • luxosaucer13 says:

      I feel your pain. At a former job, I was forced to have United Healthcare as my provider, unless I wanted to pay full retail for coverage. In my area, there were 8 doctors that were UHC “preferred providers,” no specialists, and the coverage I had did not allow for out-of-network care. Now that I’ve switched jobs and healthcare companies, I’m much better off. I still long for single-payer. One’s healthcare choices shouldn’t be tied to their job or ability to pay.

      • cspschofield says:

        “One’s healthcare choices shouldn’t be tied to their job or ability to pay.”

        Why not? Should doctors be indentured servants of society; working for a minimum amount of money?

        No person has a natural right to anything that somebody else must pay for, or slavery still exists.

        • Pre-Existing Condition says:

          Linking health insurance to one’s employer is simply idiotic. Punishing those who want to buy a policy outside of work, via the tax code, is even worse. If you’re not happy with your current policy, there should be options.

        • highfructosepornsyrup says:

          Nobody said anything about HOW MUCH a doctor should be paid. This is all about WHO should be doing the paying. As for the your second proposition, that’s also nonsense. By your definition, the only way to abolish slavery is anarchy. (I guess you could be an anarchist though… I dunno…)

        • castlecraver says:

          You are wrong. You are wrong and it disgusts me. Because you and many others like you are so wrong, our civil society is in real jeopardy.

          Doctors as indentured servants is just a loaded non sequiteur. There is no reason to believe the physicians’ profession would become even remotely slave-like under a universal health care system. But you know that, and so do the Faux News blowhards who taught you to say it. This is why we can’t have a reasonable discussion about fairness and sacrifices, why appallingly inhumane statements like “it’s not my job to worry about those people” don’t really shock anyone, and why generally accurate statements like “you didn’t build that” get ripped out of context.

          Jefferson wrote of the inalienable rights, “life, liberty, and the pursuit of happiness.” Why doesn’t fair and affordable access to quality healthcare fall under this philosophy that our country was undeniably founded upon? We all pay a little so that we all can be safe — do people who live inland object to that tiny percent of their taxes that might go to support hurricane victims, for example?

          We need to eliminate this toxic mentality, as if it’s not in all of our best interests as a civil society that everyone, including “the 47%,” are safe, free, educated, and healthy.

        • Coleoptera Girl says:

          Agreed… but there still should be good options for people who can’t pay. I know that if I can’t pay for potentially life-saving procedures should I develop the need for them, I’d like to have at least good end-of-life care. Pain management comes to mind, as does removing meds that hurt more than help or adding meds that will reduce symptoms.

          No, Jane Doe next door shouldn’t be given money to go see some celebrity doctor for her recurring, debilitating migraines or whatever, but she should still be able to get the medicine she needs to keep her as a functional member of society as much as possible. Or, you know, not leave her laying in bed in the dark wishing she could cut her own head off because of the pain.

        • zz9 says:

          So does that apply to Police officers? Firemen? The Army? There are millions of Americans working for the government serving the whole population. Why not doctors and nurses?

        • luxosaucer13 says:

          @cspschofield:

          Since when does a single-payer healthcare system translate to doctors and nurses living their lives in slavery and servitude? Healthcare professionals who work in countries with universal healthcare still get compensated very well, else they wouldn’t be doing it, now would they?

          Try a little logic to your arguments next time; you might get a little farther that way.

          “No person has a natural right to anything that somebody else must pay for, or slavery still exists.”

          So I guess that means that everyone who pays taxes for all the things that society benefits from are considered slaves, using your logic?

          If you’re not already collecting Social Security and/or Medicare benefits, are you going to forego them so that you’re not “forcing” someone else into slavery? Are you going to stop driving on public roads or using public services when you need them? Are you going to forego applying for unemployment benefits if you lose your job through no fault of your own, just to prevent “slavery?”

          I didn’t think so.

  7. jbandsma says:

    Check the fine print on your policy. There’s a line there that says “valid only until needed”. /s

  8. dush says:

    It’s a faceless corporation but behind those requests by the father some actual person is sitting at a desk being either an idiot or an incompetent.

  9. Pre-Existing Condition says:

    If anything comes from this election, I hope it’s health insurance tax parity. It’s ridiculous that people are essentially penalized via the tax code for buying a non-group policy.

    If our leadership is committed to private health insurance, the link between insurance and employment needs to be broken. At the very least, don’t penalize those who choose to buy an individual policy if they’re not happy with what their employer offers.

    • smartypants503 says:

      Can you explain a little better as to what you mean? Usually the individual policies are far more expensive than group, and you can reduce your tax burden for out of pocket expense with a cafeteria plan.

      • Pre-Existing Condition says:

        Individual policies aren’t always more expensive.

        Premiums paid via a group policy are paid for entirely with pre-tax dollars but those bought outside of a group are entirely after-tax. It’s a hefty tax penalty when family premiums are in the $10,000+ ballpark.

        I’m running into this now. I dropped my policy through work when the rates were bumped up to $1,200/month. The downside is that my premiums are now taxable (premiums can only be deducted for the amount that exceeds 7.5% of AGI). I’m still saving close to $10,000/year but my taxes have gone up considerably.

  10. smartypants503 says:

    Aetna is the worst. When my daughter was born the hospital didn’t really push us for her name. They simply put “Baby Girl Smith” on the paper work. Aetna had (has) a rule that you had to disclose your primary care physician BEFORE you went to see them. If you didn’t…sorry denied. So needless to say we get a bill for the whole child birth and our 1st doctor visit 7 days after she was born. The person at Aetna treated us like we were retarded (not an exageration). Had to get HR on the phone to straighten out what was an obvious and honest mistake and in no way our fault.

    I think that even if we get some sort of single payer or government mandated insurance program, that we just need all of the companies to get on the same page. They all seem to have thier own rules that can jepordize coverage for stupid reasons.

    If you have an auto or a homeowner policy you know that it will cover X,Y and Z. Comapnies can ADD to a base policy and they should be able to in order to compete. But if you back into a parked car or your house catches on fire you know for a fact that it is covered or not. None of this “oh someone broke into your car 10 years ago so we have to deny this claim” or “your house is painted pink? We don’t cover pick houses without a referral.”

    • Pre-Existing Condition says:

      Our insurers have always been very eager to get our newborns onto our policies. As soon as as they leave the womb, premiums shoot up, and the child gets her own deductible.

  11. kanenas says:

    My guess is because so many people have fallen for the tripe that “health care should be free” like it “is” in “other countries.”

    • Kuri says:

      People know it’s not free because their taxes pay for it. The point is that it feels free because that reduces the cost for everyone.

  12. and_another_thing says:

    Aetna is the insurer through my employer. Last week they rejected a prescription that is a continuation of treatment started weeks ago. Rather than pay the much larger full price, I started the appeal process and am continuing to use samples my doctor provided.

    Until this, Aetna had treated me okay (not great, but at least okay).

    • Pre-Existing Condition says:

      For that reason, it’s almost easier to just have a HSA. You don’t really worry about what’s covered or not covered, you just pay for it all out-of-pocket with your HSA, with the money you save on premiums.

  13. Beauzeaux says:

    Many years ago, I worked for Aetna, processing medical insurance claims. It was very weird because we did everything we could to PAY benefits, not deny them. Some cases were incredibly complicated and I’d spend hours sorting through stacks of paper so we could PAY the doctor,hospital, clinic. I actually felt it was an honorable job.

    The changes in the industry over the decades have been horrible. I feel sorry for anyone trying the negotiate the shoals of insurance company duplicity.

  14. Mr. Bill says:

    “factually inaccurate” is that anything like a lie?

  15. K says:

    We have the best health care system in the world, and anyone who says or proves different is a no good red commie.

    What would you prefer? A system where anyone can go to any health care provider that they want and be assured of a good value and get it covered by their health coverage?

    Madness!

  16. hugothebear says:

    That’s why I love my Aflac policy, I get paid money directly to at least hold me over

  17. momoftwokids says:

    Been there, done this with an insurance company (not Aetna).

    MRI found a tumor on my spinal cord after I started losing feeling in one leg and having terrible back pains that sent me to the ER. Insurance company sent me to in-network local neurosurgeon. Spent 90 minutes past appointment time waiting, finally got into room and spent more time handing over my drivers license (?) for them to photo copy than I actually spent seeing the doc (he was in and out of the room in less than 60 seconds having not actually touched me at all, not even a handshake). He prescribed physical therapy – FOR A TUMOR???

    Walking out to the parking lot I called my regular doc to find someone actually competent. She know of someone that specialized in this and asked my insurer for a out-of-network referral. They refused and told me I had to travel 300 miles to one of their in network medical centers and see someone there.

    Playing along with the game, I called the insurer’s medical center, made an appointment and sent my MRI. They called me back and said that they didn’t want to even attempt the procedure and they wanted to refer me to…..the original specialist that my doc couldn’t get the referral for.

    Called up insurance company again and it took getting one of the docs at their own medical center to tell them that the surgery couldn’t possibly be done in network and to approve the out-of-network referral to the specialist. Insurance company decided to think about it for 12 WEEKS while I lost more and more use of my leg.

    Finally get the referral to the specialist on a Friday, he sees my MRI and asks me if I can check in and have the surgery on Monday, but when I mention the name of my insurance company he flinches. Took ANOTHER 6 weeks before they approved him doing the surgery during which time my nerve damage progressed some more and even then they didn’t want to pay for him to have a pre-surgical MRI to see how far the tumor had progressed while their system screwed me over during the months and months.

    After the delayed surgery I am left with a permanent nerve damage and disability because of the insurance companies delays of over 4 months.

    • highfructosepornsyrup says:

      Grounds for lawsuit?
      First neurosurgeon for malpractice.
      Insurance company for breach of some kind of fiduciary duty.

      • momoftwokids says:

        And that would go about as well as the poor Dad in his dealings with Aetna above. Insurance companies are kind of like banks and invulnerable.

  18. keneight2 says:

    I’ve been with Regence for about a year and a half now and just have never even used my policy, but was just rewarded with a 30% increase in my monthly premium on top of the ~12% increase earlier in the year. Awesome!