Death by HMO

Okay, so I probably won't die while I'm waiting to get the referrals required by my insurance company, but I have wondered how many people who have very serious medical conditions are in situations similar to mine, not being able to see an approved doctor until the referrals and records are in place. At this point, I have been waiting a month to see the specialist. A more serious condition could certainly have at least progressed in that period of time, and to be truthful I don't know that mine hasn't. And for the rest of this year, at least, I'm stuck with this insurance company.

Insurance has to be the biggest scam on earth. The only other option is to roll the dice and not get insurance -- and hope not to have any major medical event. You pay your premiums, and if nothing happens, you don't get any of that money back. If something does happen, you have to jump through hoops to get all the coverage you're paying for and hope (in cases of car and homeowners' insurance) that your rates don't go up. If there is any reason I ever regret having left my full-time job, it's because I miss the better insurance coverage.

However, I noticed last week, as one of my sons was signing up for insurance through his work, that even medical insurance through the workplace isn't as straightforward as it used to be. When my son asked for my help, the first thing I said was, "Don't get an HMO plan! Get the PPO!" But when we were on the phone and both looking at his workplace benefits page, those weren't even options. The two choices were (I think) HRAs and HSAs. We both read through all the information and together we still couldn't figure it out. I think the insurance companies present the information in an intentionally confusing way, vague enough so that they can try to wiggle out of paying when the time comes. (I don't want to say the name of the company my son works for, but it is one of the largest financial institutions in the country.)

While I believe that the intentions behind the Affordable Care Act were humane and sincere, and a lot of people who couldn't otherwise get insurance are now able to, it has served to mess up an already-messed-up industry. Insurance companies have found so many loopholes to keep from having to pay out, such as dropping in-network or "preferred" providers without notice, reducing lists of approved medications (as an example, with my new insurance, my generic Celebrex went from four dollars to sixty-five dollars a month), and challenging valid claims. I brought some of this up with my gynocologist last week at my annual exam, and she said she knew I wouldn't want to hear this but patients need to read through their insurance information thoroughly to understand their benefits. My reply was that, especially in an emergency situation, there wasn't time to do that, and really one would need to do an almost-daily review of the policy to catch the sneaky changes the insurance companies slip in. And we're both right. Figuring out medical benefits -- providers and pharmacy charges -- is a full-time job. I already have a job. In fact, I have several. Now I guess I have another -- but only if I want to receive care and not get stuck with tens of thousands of dollars in medical bills.