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Insurance Fragsters

Over the summer, the company I work for began offering group health coverage for the first time in 18 months. Unfortunately, it was nowhere near as affordable as the coverage they offered previously, which was based out of Kansas. The new Texas-based coverage was literally three times more expensive, to the point where I couldn’t even afford to insure my family. I opted out and signed up for an individual HSA plan instead.

While everyone else at the company (all of whom either had fewer people to insure or more money than I) went through the signup process for their new plan, they all soured pretty quickly once they realized just how much more they were paying for how much less coverage than what they’d had before. One of my colleagues was asking our boss about how the premiums worked, and how often the insurance company could jack them up. Although our boss was trying to find the silver lining, my coworker kept bringing up a bunch of valid scenarios in which the rates could skyrocket.

Finally, after he brought up another hypothetical rate-increase situation and asked the boss “What do we do then?”, the boss replied in exasperation, “I don’t know; I guess we’ll just have to fuck it and pay!”

We laughed over it later, because given all of the trapdoors that our health insurance company had seemingly planted beneath our feet, “Fuck It & Pay” seemed like an appropriate slogan for them. That was when I faked up the image below to help lighten the mood.

Blue Cross & Blue Shield: Fuck It & Pay.

It’s not like I can really claim some superior position in all of this, because our family’s HSA account is with the same insurer. It’s just an individual plan vs. a group plan. I’m not blind to the fact that the group plan offers somewhat better coverage and slightly better shielding from potential arbitrary rate increases, but the fact that the premiums commanded by the group plan would have made it impossible for me to actually use the coverage (it still carried a $5,000 deductible on top of it!) reduced the idea to literal absurdity. Our individual HSA was and is the only realistic option.

While we’re speaking of absurd, get a load of the letter our health insurance company sent to us today. Since we were accepted into their ranks as policyholders a few months ago, my wife decided to go in for a routine physical which she hadn’t done in probably six years or so (at least, not in the United States; we tend to save that kind of stuff for our trips to Thailand, given how affordable it is there). After her physician found a couple of lab results that were slightly off normal — mostly vitamin deficiencies and such, nothing to get excited about — our insurance company dropped us a line asking us if we would please make a list and re-send to them the names and contact info of every physician my wife had ever visited in the last five years.

Never mind that we just did all of that (going back ten years, no less) when we applied for coverage, since that was obviously a condition of coverage being extended to us in the first place. My wife and I don’t go to the doctor much, and when we do it’s mostly either Chinese acupuncturists / herbalists or overseas physicians, meaning that there’s usually no records to show and even if there were, they’d be overseas and nobody would be able to retrieve them. So there really isn’t much of an audit trail for any of us.

Nonetheless, a little sleuthing allowed us to see what the insurance company was probably up to. Because my wife went back to her doctor for a follow-up consultation after those lab results came in, the insurer saw that and decided “Hey, this patient didn’t show us any history of vitamin deficiency when she applied for underwriting. This would be a great opportunity for us to go back through her files and see if we can prove she had a problem with this before, so we can deny all coverage for anything even tangentially related!” Then, when they didn’t find anything, they sent out a “Show Me Your Papers” gestapo-gram asking if we’d re-send all medical history going back five years, just so they can make really really make double extra-sure that there’s no way they can somehow wriggle out of their end of the deal.

As if the spirit of this “gesture” wasn’t rude enough, there’s that whole underlying current of extreme overcaution bordering on paranoia that infuses itself into every interaction you have with an insurance company. This infusion, naturally, is a result of the confiscatory and punitive nature of healthcare in the U.S., where you’re just as likely to be fucked as you are to be healed, and it’s incumbent upon you alone to avoid the former while receiving the latter, even while you’re half-conscious and bleeding to death. So on today’s letter asking for medical history, I noticed that there was a box you could check to indicate that you’d already told them everything you could possibly tell them; i.e., during underwriting.

Immediately I’m thinking: “What if that checkbox is really the key to this whole letter? What if, by not checking it and submitting additional history, you’re admitting that you omitted history from your application? And could they not use that as grounds to terminate the policy for fraud or whatever?”

Hey, come on. Don’t tell me that the thought wouldn’t cross your mind, too.

I found myself asking this question because there were a couple of “physicians” we didn’t put on my wife’s application, because they either weren’t actual physicians (i.e., Chinese herbologists) or weren’t providing a service related to anything our policy would cover (i.e., maternity). Now the paranoia sets in afresh, because maybe the insurance company wants those names too? Even though there are no records to collect even if they went to some of these doctors’ offices and asked for them? (I’d love for them to call up my former acupuncturist in Naples, an old guy who kept records in his head and would only write them down if you asked for them — then promptly give you the only printed copy.)

For a few minutes after reading the insurance company’s “summons” I got pretty incensed, as I am wont to do. I verbally rattled off a whole bunch of things I could say if I got them on the phone. Threatened to really turn the tables and demand something of them in return, such as an explanation for why, after submitting 10 years worth of bullshit to underwriting for the sole purpose of giving them ammunition that they could use to not cover something, they were making us do it again just a few months later. At one point, I even decided that I was going to tell them that they already have our identities, our social security numbers and all the political power and money that they need to find whatever information they need, and so my recommendation was that they go find it because I sure wasn’t going to make their lives easier by handing it to them on a lace doily.

In the end, we decided to add one additional physician to their much-vaunted form — a man who my wife saw briefly in Florida for a completely unrelated consultation regarding something our policy doesn’t even cover, and which certainly had nothing to do with vitamin deficiencies — and send it back sans remark. No research, no hair-pulling, no phone calls with layers of questions. I’m not going to ask what’s really going on because, in the end, I’ve decided that I don’t give a shit. Knowing the full details behind the insurer’s machinations doesn’t give me more options, doesn’t change how I react and doesn’t alter a damn thing.

My wife’s already decided that she’s probably not going to visit the doctor anymore, since apparently a full state security investigation is opened by the insurance company anytime you do. I can’t say I blame her. The same companies who pay overstaffed, undertalented marketing departments thousands to deploy touchy-feely campaigns encouraging you to get regular and routine preventive care so you stay healthy are also ready to anally probe you the instant you do, and I’m convinced they’ve got actual klaxons that sound in their offices if even the slightest abnormality is discovered. It’s a giant lie, a waste of time and little more than a toilet you flush money down, at least until you get an arm shot off by a cannonball and find suddenly that you need a $200,000 surgery to glue it back on. If not for that, I wouldn’t even pay these scum at all.

With elections right around the corner, and health care one of the hot topics of the day, I suppose you could make a case that a situation like this might have a sizable impact on one’s politics. In the end, though, I feel that insurance companies — like many large corporations in the U.S. today — would have no trouble finding an excuse within the policies of either Mitt Romney or Barack Obama to charge us all more, offer less, and step up their scrutiny at every turn. Because when you have a business model (insurance) that’s literally built on taking in maximum dollar and returning the fewest services possible, and then compound that by making them publicly-traded companies beholden to stockholders who want a return on investment above all else, what do you really expect?

But we’ll all go on paying them, because really, what are you gonna do? Not get insurance?

4 thoughts on “Insurance Fragsters

  1. Oh insurance.

    One of the things I most hate is the way insurance companies make you feel as if they a doing you such a huge favor by giving you the very service you ‘ve paid for. I abhor paying for the privelege of being screwed. And insurance is so good at doing that.

    1. My thoughts exactly.

      Since we sent off that form with the one additional doctor on it, we’ve come to realize that it’s likely we already told the insurer about that particular physician after all, so I guess they aren’t gonna be learning anything new.

      I asked our insurance broker about this and she’s seen it before. Turns out I was right about it being a fishing expedition for pre-existing condition evidence that they could use to deny coverage, although she said she has never seen it result in a retroactive reduction in overall benefits or termination of policy. Regardless, there is no pre-existing condition for them to find, so it’s moot.

      The real kick in the mouth for me, I think, is knowing that if you ever wind up half-dead from illness or injury, you still have to muster the strength to watch your back for the insurance company screw. It’s like the cable company that sends you a letter saying, “Sorry your house was struck by lightning and burned to the ground along with everything in it, but we’re gonna need you to immediately pay us $2,000 for the loss of the cable boxes and DVRs you were renting.” As if some enormous corporation’s balance sheet is anywhere near the top of your priority list in such a situation…

  2. I thought they couldn’t deny for pre-existing conditions anymore anyway? (Obamacare provision?)

    At work right now we’re doing a life care plan for a 10 year old with cerebral palsy. The auto insurance company is going to have to pay upwards of 40 million dollars for her lifetime care. She was born prematurely because her mother had a car accident – it wasn’t even the mother’s car, and the mother had been smoking marijuana at the time of the accident. Unfortunately it’s because of cases like this – and there are thousands of them – that insurance companies get all over us little folks.

    The old Catholic school philosophy again. We all pay for the mistakes of a few.

    1. Someone once told me that the Obamacare provision prevents them from denying coverage to new policy applicants who have an existing condition. i.e., if you lost your coverage while you were sick because you lost your job or something that was no fault of your own, you would still be able to get replacement coverage. However, while they have to offer you a policy, I don’t think they have to make it affordable!

      Yeah, I think fraud is a significant part of health insurance (and insurance in general) costs. Like the one story you were telling me about where the guy claimed he was taking care of his disabled mother, so he could claim all of these government subsidies, except he wasn’t actually taking care of her at all.

      Love that Catholic school philosophy. Funny how it keeps cropping up. Actually isn’t it more of a Catholic philosophy in general? “Original Sin”, and all that? In their view we’re born paying for someone else’s mistakes. They’ve certainly made an art out of using fear as a motivator.

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