The appointment was at 9 am sharp. The surgeon was supposed to remove a cancerous lesion off the BF’s face, right next to his right ear. Kaiser Permanente had texted, called, and emailed to remind him of the appointment.
The surgeon was more than half an hour late into the exam room.
He informed the BF that he would not perform the operation, that the BF had no insurance, so he had to leave. Immediately.
To say the least the BF was incensed. He had by this time lost a half day of work when you combine the drive, the wait, the conversation with the recalcitrant surgeon and the drive back.
Here’s the piece: Kaiser, which has been the BF’s insurance company for some time, cancelled his insurance for non-payment.
Except that they had been, and continued to, deduct monthly payments from his checking account. These payments were automatic. No changes had been made by the BF. Kaiser was regularly paid in time. For a long time.
However, back in January, Kaiser had raised their rates, but failed to change the deduction amount from the BF’s account. He’d had no clue. As far as he was concerned, Kaiser Permanente was being paid as agreed.
Except apparently Kaiser Permanente felt differently, and sent him an email announcing that he’d been dumped for non-payment.
Except that they had been paid, regularly, consistently. Kaiser hadn’t raised the deduction out of his account, so they dunned the BF right in the middle of a cancer treatment.
The only times an insurance company can legitimately cancel you are:
- You’ve put false information or incomplete information on your application.
- You commit fraud.
- You don’t pay your premiums on time.
Even so they must give you a 30-day notice in advance. And depending on your healthcare program, they are also required to give you a 90-day grace period. This gives you time to appeal or find other coverage. No insurance company can frivolously cancel you on a whim. Or, if you get sick, which is what they used to be able to do. This is called recission. Your illness, which is a severe impediment to their profits, was once used as a reason to dump you without warning, and make you completely uninsurable going forward. This is now illegal. At least for now, until the powerful industry lobbyists find a way to bring back an insurance company’s right to dump you when you dare to use the products you’d paid out the nose for. What a nerve we have to need health care. Indeed.
Staggering health cost is the number one reason Americans file for bankruptcy (https://www.usatoday.com/story/money/personalfinance/2017/05/05/this-is-the-no-1-reason-americans-file-for-bankruptcy/101148136/). While the actual numbers of those who filed due to medical costs vary depending on whose study you quote (https://www.thebalance.com/medical-bankruptcy-statistics-4154729), the fundamental truth is that America is the only country in the world where this happens. Add to that the billions that insurance companies (and pharma, and healthcare) spend on lobbying and you get a very clear picture that nobody frankly gives a sh*t about your health, only your wallet.
As for how we compare to other countries and whether socialized healthcare is an answer, here is some recommended reading: https://www.thebalance.com/universal-health-care-4156211.
At any rate we’re a mess, and getting worse. The situation with the BF is a perfect example.
Here’s the piece that makes no sense. The BF is a superb athlete. Healthy, hearty, hale. He has rarely, if ever, used his insurance. He is the kind of person insurance companies are simply dying to get onto the rolls because his payments are almost pure profit. Health insurers bitch bloody murder because they don’t have enough folks just like the BF: healthy, responsible, regular payers who rarely need coverage.
Yet Kaiser dumped him right in the middle of a one time skin cancer treatment for “non-payment” due to a mistake that Kaiser made, not the BF.
There followed multiple calls, inquiries, emails. Promises to get to the bottom of the problem. And multiple reminders and instructions to go ahead to the surgeon’s office and get that cancerous lesion removed. After all, it’s right next to his brain. Might be a good idea, right?
Until the doctor, despite the three reminders from Kaiser, kicked the BF out of his office for being uninsured.
When the BF was still at their offices, he was face-to-face with the nurse administrator who gazed at him with the bovine incomprehension of the terminally stupid (which, please, my apologies to cows all over the world, who are all clearly brighter than this dim bulb) when he asked what the hell was going on. Righteously angry- and I would be too- he got in her business and asked her what she was useful for if she couldn’t help out with this kind of problem. A real problem with real potential consequences. She stared back wordlessly, uncomprehendingly. A deer in the headlights. Here was a very real patient issue and she had no clue, no idea, no answers.
Utterly and criminally useless.
The BF demanded to know, what on earth are you here for?
Excellent question. She had no answer. The BF and I have an answer and it’s not printable.
This is our healthcare system.
The BF is now seeking legal representation and has filed multiple complaints not only with Kaiser but also with the Colorado insurance commission which oversees the Kaisers of the world. He has filed a complaint against the doctor. I would, too.
This is our healthcare system.
While there is plenty of recourse for those who have had their insurance cancelled for any number of reasons, the problem is that in the middle of critical healthcare this can be both terrifying and disconcerting. Insurance companies are required by law to give you thirty days’ notice that they are going to cancel and also, why.
The BF was already bracing himself for premiums of $800+ a month beginning next January- and this for a superbly healthy 49-year-old man with virtually no health issues whatsoever. That’s already a travesty of the highest order, especially since Kaiser will be banking nearly all of that cash. Almost ten grand a year pure profit and that’s just with one person.
Now, given that insurance companies (at least for now) HAVE to provide care, and can no longer boot you to the curb forever if you come down with the common cold or have the nerve to get raped or pregnant. Those, which insurance companies used to consider pre-existing conditions, can still be held against you (guilty for being female in other words) because both meant that — GASP — you might need additional healthcare. Depending on your state, and here is where mid-term elections become handy tools for kicking the bastards out- the GOP wanted to allow them to choose to charge more. Female? The Pink Tax (https://people.com/chica/6-facts-you-need-to-know-about-the-pink-tax/). Shame on us for being female. We should be FINED.
Um. We ARE being fined.
As a disabled veteran, I get all my healthcare from the government, for which I am supremely grateful. As I watch the BF struggle not only with the entrenched stupidity of organizations which serve one purpose and one purpose only — limited coverage for maximum cost — I have run into the same issue when I’ve had to go out of the VA system for care. Recently I needed an MRI on a shoulder. Because of the pain and the inherent delays in working with the VA, I offered to pay for the MRI myself.
At the end of a twelve-hour day which had been a lesson in extreme agitation dealing with intransigent government organizations, I called the imaging company and told them I’d be willing to pony up for the MRI. They quoted me $1050 for out-of-pocket costs. Then the woman said that they couldn’t let me pay for it myself out of pocket because I was a VA patient.
Let’s read between the lines. The insurance company doesn’t get its share if I pay cash. They want to rip off the VA for additional monies. So they wanted to block my MRI so that they could skim off the top.
I went back to my surgeon, who arranged for me to get an MRI at his offices. Cost? $355. Cash out-of-pocket. In other words the imaging company jacked up the rate for out-of-pocket by a factor of three, so who in the world knows how much they would have raked the VA for the same services? I promptly paid the $355 and got it handled.
This is your taxpayer dollar at work.
Screw the insurance companies. Unfortunately, they screw us all the time. I’m immensely lucky, since I have the VA. As frustrating as they can be at times, and any vet can attest, this much I know: I won’t have my coverage cancelled because some inept a**hole didn’t take care of business or drop an essential detail. At the VA, however, the snail-slow process of getting seen, getting authorizations for critical care can be so frustrating that thousands of veterans who are in high need end up committing suicide- this is particularly true for those needing mental health care. I can fully understand why.
Competent, capable, knowledgeable employees are a very rare commodity any more these days, with nearly full employment combined with a high cost of living meaning that the best and brightest go to the highest paying jobs. When a low-level employee handily “forgets” to take care of business with your automatic deduction, that could trigger a cancellation at any time.
Including right in the middle of critical care.
Let’s just hope to hell you aren’t having a heart attack at the time.