True health care reform should start with insurance companies

Here’s something you already know: Cancer sucks.

This isn’t news to anyone, whether they or someone close to them have had it.

And most people know most of the negative connotations associated with this debilitating and life-threatening disease: the chemotherapy, the inevitable vomiting and fatigue, hair loss and suppressed immune system. Those who have experienced the disease first hand can also tell you about bouts of depression, desperation, chaotic daily routines, a yearning desire for life to simply return to normal and fear … lots and lots of fear.

But there’s another obstacle in most folks’ battle with not only cancer, but any kind of long-term medical issue that is as maddening and infuriating as it is unnecessary: battling health insurance companies.

It was nearly three years ago my wife was diagnosed with breast cancer. With the exception of the vomiting (amazingly) we experienced everything I listed above, in addition to navigating through those treacherous waters with minimal impact on our young children.

Cancer is always difficult, but in many ways we were blessed. My wife not only was able to avoid the most treacherous side effects of chemotherapy, we were also fortunate to receive a great deal of emotional and physical support from family and friends.

Some of those family and friends who had dealt with cancer or some other long-term illness had wisely warned us about dealing with the health insurance companies.

Check everything twice, they said. Be ready to fight. And fight. And fight some more.

They were right.

Properly forewarned, I readied myself for battle and have spent more time than I want to know on the phone with whomever answers the 1-800 number on the top of the explanation of benefits that accompanies any claim to the insurance company. The person on the other is usually very polite, and always apologizes for the standard 30 minute wait, during which time I’ve done everything from practicing the trumpet, to watching a ball game, reading a book, or playing solitaire on my phone.

My most recent tete-a-tete was finally resolved last week after a healthy 9-month run that started with a routine scan last November.

Them: Claim was denied because the scan was experimental.

Me: No it wasn’t.

Them: Then it was coded wrong by the hospital.

Me: No it wasn’t.

Them: Oh, you’re right. We’ll send out a check in a day or two.

In real time, that’s a 23-second conversation. In reality, that conversation lasted from Jan. 15 through Aug. 9, and included a four-month review by the hospital’s auditing unit, a letter from the same hospital informing us we would be turned over to collections if we didn’t pay the bill they were reviewing that we were then told to ignore, and a secondary review by the insurance company’s “adjustment review” team that was only instigated following the hospital’s investigation.

I have no idea why it would take four months to determine something was coded correctly. I have no idea why I was even told the code was incorrect.

What I do know is this is unacceptable, far too common to the point the American public has become numb to the financial and emotional pain it can inflict when left unchallenged.

Going through any major illness is enough of a burden on its own. You really don’t need the added stress associated with bills that should be paid. I can only imagine the number of physically and mentally exhausted people who simply give up or don’t fight at all and fall victim to what can only be labeled a predatory practice.

My experience is not unique to one health insurance provider, hospital, clinic or doctor. It’s reflective of far too much of the industry to the point we as consumers know the 500-pound gorilla is in the room, but we simply accept it and cope instead of giving the ape a bath and some clothes to wear.

With the primaries in the rearview mirror, we’re going to hear a lot of political chatter the next few months, and if this election is like any other election since the 1990s, health care will be a major topic. While they won’t disagree to what extent health care is broken, Democrats and Republicans alike will all have their own brilliant plans to reform the system and bring cheaper costs yet better care (it’s magic!).

While most of those changes will focus on things like coverage, costs and who pays the bill, what would really be nice is establishing regulations to better monitor insurance providers while prohibiting loopholes like the one that allows all claims appeals to be denied if they are not contested in a short period of time.

That’s the kind of health care reform we need.

That’s the kind of health care reform that will matter to millions of Americans.

——

Gregory Orear is the publisher of The Journal. His award-winning weekly column, “What’s Going On,” has been published in four newspapers in three states for more than 20 years. He can be contacted at gorear@nujournal.com.

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