Wednesday, July 1, 2009

Insurance Fraud

I had one of those moments this morning when I read something and it makes me want to kick something. Hard. Today it was a New York Times article about the under-insured. It features a couple named Larry and Claire Yurdin who've been brought to bankruptcy because their health insurance covered hospital stays but no procedures. The patient, Larry Yurdin, could sleep at the hospital, but blood tests? Not so much. Here's a choice bit:

"Insurers like Aetna generally defend limited-benefit policies as a byproduct of the nation’s flawed health care system, which they say makes it too expensive to adequately insure someone like Mr. Yurdin."

So Aetna sells health insurance but they can't make enough money to insure people if they're going to get sick and it's just not their fault. Riiiight.

I once had Aetna insurance through a Cobra plan. While covered by Aetna, I had to have a diagnostic procedure, a surgry that was the only way to figure out if I had a specific condition. When I didn't have the condition the surgery was assessing, Aetna refused to cover it. The procedure's cost for a regular person (that is the uninsured) was $15,000. Aetna would have -- and eventually did -- pay significantly less. That whole thing sucked. Then, when our Cobra coverage was running out, my husband and I went looking for other insurance. At the time I was trying to get pregnant. Desperately. Frantically. Impatiently trying to get pregnant. But most inurance plans available to us wouldn't provide coverage for maternity care. "Oh you just pay the OB, five thousand and that takes care of it." Right. And if I had had any complications? Required any special testing? What about a hospital stay? My relatively uneventful pregnancy involved all three. If I had had the non-maternity coverage, who would have paid for all of it? Moreover, if I had actually become pregnant before switching coverage new insurance wouldn't have covered my pregnancy because it would have been considered a "pre-existing condition."

Now we have insurance through my husband's job and I can't even get started on how bad they suck. I can't. Its so boring and everyone has heard the stories before. The evasions, the delays, the out and out lies. It's just gross. These are the gatekeepers to our health care system. These are the people who've argued against coverage and who now claim (according to the Times) that if everyone were covered they could do a better job insuring. All I can say is these insurance executives and lobbyists better not be involved in the new health care plan. That'd be kind of like having veteran Wall Streeters figuring out how to fix our broken financial system. I mean, that would be nuts, right?

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