Originally created 02/22/99

Column: Health insurance industry desperately in need of people-friendly changes 022299 - The Augusta Chronicle



Normally, I hate to bust out harshly on any issue. But I'll share this anyway. Health insurance companies can be the lowest form of prehensile life that crawls the earth. No. That's not strong enough.

Some are as loathsome as the putrid slime that clings to the walls of hell. I forget where I read that line, but it's got the best sense of it. Now, I'm willing to listen to any insurance person who wants to disagree, provided they can personally match my personal experience with their industry. I'm reminded of my trials at the hands of insurance bureaucrats after reading about 10th District Georgia Rep. Charlie Norwood's new proposal to reform their business.

I WON'T GO into my personal health travails. I've spent enough hours in waiting rooms to know there are plenty of people out there with worse stories than mine. But for them and me, it seems that insurers would rather see you get sick and die than to do the right thing. Of course, some people are what retailers call "loss leaders." They are sick. There's no way they could ever afford to pay the zillions of dollars it costs to treat grave illness.

AND THE LONGER they live the worse the impact on the insurance company's budget. It is in their interest that people don't survive deadly sickness. Failing that, if a patient does manage to hang on, it's in the insurer's interest that they don't hang on too long.

Looking at all this strictly as a business proposition, I can see where they're coming from. If my Christmas bonus depended on how miserly I could be with health care claims, I might feel the same. Provided, of course, that I completely lost my conscience and sense of human decency.

THE MOST frustrating thing in my experience can be expressed very simply. What happens to the patient when the health care provider demands more money than the insurance company wants to pay? There is a five letter word to describe this process. It's a noun used as a verb in the past tense. It describes a small piece of metal you drive into wood with a hand tool.

LET'S SAY YOU need your eye out. The doctor wants $5,000. The insurance company will only pay $2.50. The insurer says in code so cryptic the CIA couldn't crack it that $2.50 is all the doctors in your universe charge for eye removal. You call the doctor. He says that's crazy; the going rate for putting out your eye is $5,000 not $2.50.

The doctor won't back up his fee with any evidence and the insurance company would rathersee you in a warm place beneath the earth before it will tell you exactly how it arrived at the $2.50figure. If you need your eye out to save your life, and you don't have $4,997.50 difference, then you can kiss your backside goodbye.

IF YOU HAVE your eye out first and worry about the bill later, the provider will eventually call the goon squad, also known as a collection agency. Now you're sick in two places, your eye and your heart. Nobody cares except your dog. Nobody will give you the information you need to deal with the dispute yourself.

I've had insurance bureaucrats pat me on the head, figuratively, and say I was too dumb to understand how they do their math and that even if I was as big a genius as they were, they wouldn't share the information anyway. It's proprietary. The corporate equivalent of a police secret.

Now, some have argued that the best way to go is to allow a patient to sue the insurer if his or her health is harmed by all this. I used to agree with that, but no longer. After reflection, I really don't care if my heirs have the right to sue these miserable people or not.

I would like an immediate, impartial resolution of my dispute, from treatment approval to fees, by somebody who can make these opposing forces divulge the basis of their decisions. Lawyers may not like this, but lots of people simply don't have time for a pricey, protracted legal battle.

I DON'T KNOW whether Norwood's bill would assist in all of this or not. But I thank him for introducing his bill for the people it may help and for giving me an excuse to write about all this.