Right Back at It. (Insurance again)

I don’t want to spend my time blogging about this. I much rather spread the message of hope to others about Luna's speedy recovery from the Fontan. But once again The Health Insurance Company has hijacked our time, money and good spirits.

So here I am, blogging in attempt to get the corrupt ways out to the masses. One, because I need to document the sheer hell that Insurance Corp puts us through, and two, I dream of testifying against all of the Big-wigs at the Insurance Companies on the floor of congress one day. I will do my small part to change the way American runs its health insurance program. In my dreams, patients who were denied treatments from their insurance carrier, who as a result died, like this little girl here, will at least not die in vein. In this country, even an accidental death can result in second degree murder. So, why should these Health Insurance Companies, who very concertedly deny coverage to people (kids, even!), be shielded from serving a term for nothing short of murder?

So, you’re not going to believe this. Here goes the latest round with Big Insurance.

While I was in the hospital with Luna-getting her through her third and hopefully last open heart surgery, The Architect called to say there are insurance problems again.

Can we just stop right here. Let me repeat: a mother in the hospital with her two-year-old, trying to get her girl through surgery, and I have Insurance issues to worry about.

Ok, moving on.

The Architect went on to explain that the latest statements had two erroneous charges on them. The total out of pocket charges on the statements? Nearly $14,000. But for now, we’ll focus on just one of them.

One charge was for $4065, in which The Insurance company states I am the consumer, and apparently on 4/14/10 I had some type of service done at UMass Memorial Health center.

That’s funny. I’ve never even been to the place. And on that date I was with photographer Greg West touring the Boston Residential Design & Contruction Show.

This is where it get’s stranger than fiction.

Paul, aka, The Architect decides to call my primary care physicians to try to make some sense of the claim.

The receptionist, a young man took Paul’s call: and explained that he too has (insert big Insurance Provider here) and got a statement with the same exact charge, also from UMass Memorial Health center.

Can’t make this stuff up folks.

Nick, the receptionist explained that when he called to contest the charges, Big Insurance responded saying, “Oh, we know what happened, there is another man with your name and same birthday, that must be it”.

Well, guess what? With this little invention called the internet, it’s pretty easy to look up to see who has your name. There is no other Nick (insert unusual last name here), with his exact birthday; month, day and year.

And that really doesn’t explain why I got the same charges. Does Big Insurance want to tell me that there is another Sabrina Velandry out there?

Nick, works in health, and his parent company, concerned and bothered by the claim, and the Insurance Company's rebuttal to it, has taken up to investigating the case. I faxed over my statement, which will be part of this investigation.

When I called Big Insurance, the woman I spoke with Beth K. actually said to me: “well, this is not the fault of (Insert name of Big Insurance carrier here)”.

Let’s just stop here to reflect upon the dysfunctional culture of the entire company. First, can you think of another company where employees do not release their last names? Tells ya something, doesn’t it. Secondly, if this was your company, and you were alerted to such an error, would you not make it priority to stop whatever fraudulent behavior was stemming from your corporation?

Stay tuned folks; something tells me this is just the tip of the iceberg.

The Anthem who stole Christmas

A week before Christmas we learned that our out of pocket (OOP) was to jump from 5K in '09 to 10K in '10 (how convenient of the insurance company to coordinate deductible with the year). The premium, increased something like $1 per pay period, which puts us squarely at $800/month for a total of $19,600 OOP for the upcoming year.

Health insurance is a major problem in this country. And I am thankful that it has been front and center of the national debate and media for the better part of a year now. But we still have a ways to go, and perhaps the for first time ever, I envy those living in Europe and Canada. Mothers who have heart kids of their own, who encounter virtually none of the financial fall-out that we are going through. Mothers and Fathers who undoubtedly are less-stressed and who are not bogged down with fights with their insurance companies. And as far as I can tell, their kids receive the same treatments and fare just as well as their American friends living with the same anatomical deformities.

The American Dream dissolves into the American Nightmare.

Every parent's wish is to have healthy children. Through the advances of medical technology, I feel we have that with Luna. It's the insurance costs that is killing us.

Take this scenario (a totally fictional account created for the sake of this argument):

Suppose you were working at a company with roughly 100 people. The company is about 50/50 split between men and women, and about 65% of the company's employees carry insurance for their entire family.

Of that 65% one woman had a baby via c-section, one family learned their teenage daughter had a rare bone cancer, and one family has a baby who, in one year alone endured 2 open heart surgeries, 2 catheters, and 2 sedated echo cardiograms.

This December the HR gal begins her dreaded and laborious task of re-upping her health insurance contracts. Of the five companies she calls for rates, the only one who will return her call is the same carrier she is dealing with now. Sure, they say, we'll insure your company. But for 2009 we where upside down 130% so we're going to double your employees out of pocket for 2010.

Now, would anyone like to tell me how this story will end, when in 2010 we *know* the heart baby will incur another 1/4 of a million in claims for her next open heart surgery, cath and sedated echo?

The entire company not insurable? Nonsense you say! But isn't what these free-market zealots wail about? "Let the markets correct themselves, let competition rein!".

Ah-huh. Except for that tiny detail that everyone seemed to forget: you cannot negotiate your health. And you cannot leverage a human life.

I love business and am currently growing one devoted to cultivating and advocating for the creative industries. I love, love, love the thrill of the negotiation. Negotiation is all about leverage. And faking to the party trying to sell their goods or services that you somehow do not need their goods. Case in point, I recently negotiated ad space. I really did not *need* this full page ad, I wanted it. The 'seller' knew this, both parties know the publishing world is hurting, so I get a great deal for my client.

Or, you want to buy that house, but there's something about it that just doesn't feel right to you. You walk away. In this market you'll find five others-better than the one you just toured. But when you know your kid is going to cost a fortune, and you know that in 2010 she'll endure more medical care than most do in a lifetime; how can you possibly walk away and find an insurance company who will cover that? A company, whose business practices and profit margin are not based upon the services they offer, but rather, on the ones they reject (wow, sounds like a pretty incredible company...how can I run one of those you say!)

So, until we somehow come to grips with the fact that health is not a 'free-market' kind of thing, and every time a health insurance company makes a windfall profit, and your stock spits out another dividend, just remember, that happened solely on the fact that the only way for an insurance company to make that windfall profit is to reject coverage for kids like Luna or, simply not insure entire companies who have one or two medically needy folks on the policy. Oh you say, but isn't that like everyone? Uh-huh.