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Chapter 23 "Stuck Between a Rock and a Blue Cross" The following is an editorial printed in the Gainesville Sun on 9/15/05 As soon as I opened the bill from my doctor, the pink neon sticker shrieked at me. My insurance company had denied a claim because "the requested information was not received." This wasn't the first time Blue Cross had expected me to be telepathic. A few months prior, out of the clear blue shield, they denied a claim saying I hadn't confirmed that I had no other insurance. How sweet, I thought, they want to know if we're going steady. I called and assured them there was no other insurance company in my life, or even the prospect of one. So what was it this time? Had I failed to tell them my favorite color? My Super Bowl predictions? Were they waiting for my essay on the diminishing Yak population in Tibet?  The friendly customer service representative informed me they had a new numbering system, so my old number was causing the billing problems. When I asked how I was supposed to know I had a new number she said, "I'm telling you now aren't I?" Fine. Blue Cross will reprocess and pay the claim, problem solved. Despite having spent forty-five minutes listening to smooth Jazz covers of Barry Manilow songs, I was pleased. I had won the battle-this time.
For a long while, the only time I thought about my insurance company was the occasional neon sticker induced skirmish or the ten minutes it took me to find the crumpled paper card at the bottom of my purse when it came time for my annual check-up. Then a year ago, I discovered my neck was the equivalent of a petrie dish whose sole purpose was to grow thyroid cancer. Eight cancerous tumors were happily bubbling in my neck. 
Getting rid of the cancer not only meant, surgeries, doctors, hospitals and a brief stint of being "too radioactive to be in the general population," it also meant I now had to interact with my insurance company on a regular basis. Sure, I had my complaints. I hated paying out the nose for health insurance only to see my co-pay go up as my prescription coverage plunged down; spending hours on the phone getting tossed around like a contaminated syringe from one over worked employee to the next; and of course, the pile of paperwork so high I'm using it as a stool to sit and write this.
But when it came to my dealings with Blue Cross, I'd been pretty consistently at Def Con level 2: mad, but not launching any bombs just yet. The war really began when my doctor called recently to say the insurance would not cover the injections needed to make sure cancer wasn't still lounging around in my neck. Without the injections I would have to go off my medication for a while, which leaves me spry as a sloth and with the mental capacity of a couch cushion. I could choose to buy the injections myself for the bargain price of my arm, my leg and my mortal soul, or I could enter the labyrinth of automated voice systems to try and fix the problem. With each person I talked to the puzzle grew more complicated. Blue Cross brought out the cavalcade of codes, excuses and catchphrases, all with the magic ability to leave me exhausted, confounded and crying. I felt like a teenager grappling with an SAT word problem. #5,007. If your denied claim left the insurance company traveling at 50mph and your medical coverage left at the approximate speed of frozen honey dripping out of a jar, would they arrive at your house in time for you to hurl your phone at the wall because you've talked to forty seven people and you STILL don't have an answer? 
Blue Cross had found a loophole. They would cover the injections only if the doctor bought them, administered them, and juggled them while riding a unicycle on a tightrope. Since no doctor in Gainesville doubles as a circus performer, my physician and I were forced into the decision to stop my medication unless I could come up with the money.
Why does Blue Cross get the final word? My doctor and I should be determining what's best for my health, NOT an insurance company that makes money based on what they do not cover.  Between my husband's employer, and me, Blue Cross has been paid $10,000 this year. Where is that money going if I can't get the one major thing I'll need?
If I add up what I pay to the insurance company, plus what I pay out-of pocket, I'm paying MORE for health care than people in countries with universal systems and getting LESS. People in those countries don't have the hassle of figuring out what will or won't be covered, filling out forms, making copies and sending them back only to have the claim denied, depleting their bank accounts to pay for something the insurance won't cover, or sitting on hold being force fed smooth jazz songs. They only listen to Barry Manilow if they CHOOSE to do so! It's painfully obvious to me that our system for getting health care in this country is failing. While I'm struggling to figure out how in the world to pay for the care I need, a camarilla of CEOs is plotting out the best way to maximize their profits. And how do they do that? By making people like me, like us, struggle, stretch and do without. I for one am tired of it. I know there's a better way and I'm going to fight for Universal Health Care in the US. Many organizations are already working to make it happen. For more information visit www.justhealthcare.org  |