This funny letter was sent to me. It comes from the Daily Kos. This letter cleverly points out all of the folks that stand between you and your doctor. Although the letter is tongue-in-cheek, the underlying message is clear. Insurance companies aren’t here to make sure that you get all of the care that you need. They are here to make money!
Dear Mr. President: I am writing you today because I am outraged at the notion of involving government in healthcare decisions like they do in other countries. I believe healthcare decisions should be between myself and my doctor.
Well, that is not strictly true. I believe healthcare decisions should be between myself, my doctor, and my insurance company, which provides me a list of which doctors I can see, which specialists I can see, and has a strict policy outlining when I can and can’t see those specialists, for what symptoms, and what tests my doctors can or cannot perform for a given set of symptoms. That seems fair, because the insurance company needs to make a profit; they’re not in the business of just keeping people alive for free.
Oh, and also my employer. My employer decides what health insurance company and plans will be available to me in the first place. If I quit that job and find another, my heath insurance will be different, and I may or may not be able to see the same doctor as I had been seeing before, or receive the same treatments, or obtain the same medicines. So I believe my healthcare decisions should be between myself, the company I work for, my insurance company, and my doctor. Assuming I’m employed, which is a tough go in the current economy.
Hmm, but that’s still a little simplistic. I suppose we should clarify.
I also believe my healthcare should depend on the form I fill out when I apply for that health insurance, which stipulates that any medical problems I ever had previously in my life won’t be covered by that insurance, and so I am not allowed to seek further care for them, at least not at my insurance company’s expense. That seems fair; otherwise my insurance company might be cheated by me knowing I needed healthcare for something in advance.
And if I didn’t know about an existing condition I had, but I could have known about it, had someone discovered it, I suppose it doesn’t make much sense for my insurance to cover that either.
But let us assume that all hurdles have been cleared and I am allowed to see my doctor, chosen from a list of available doctors, about a health problem, except health problems I have previously been treated for. After that, I believe my healthcare decisions should be between myself, my insurance company, my insurance plan, my employer, and my doctor.
Oh — and the doctors at the insurance company, of course.
They will never actually meet me, or even speak to me on the phone, and in fact I couldn’t tell you the name of a single one of them, or what state they were in, or whether or not they’ve just all been outsourced to a computer program somewhere in Asia at this point — but they’re in charge of determining which treatments might be “effective” for me, and which will be a waste of money, er, time. They do this by looking not at my case, which is individualistic and piffling and minor, but at the statistical panoply of treatments on the insurance company spreadsheet and their statistical cost vs. effectiveness. My doctor may think one treatment or another might be effective for me in a particular instance — but he may be a little too closely involved with my personal case, and unable to make these decisions nearly as well as my less involved, more dispassionate insurance company can.
And then there’s the claims office. When my doctor sends a bill to my insurance company, it must travel through a phalanx of people and departments and procedures in order to determine whether or not it is, in fact, a valid medical complaint to be treated for, done the right way, at the right time, by a doctor on the right list. If the paperwork is not done on time, or not done completely, or not done to the satisfaction of the right people, or if I did not receive the proper prior approval for the medical treatment administered, or if that approval expired, or if the insurance company rescinded the approval months after the fact, my medical care will not be covered. While my doctor has had to sometimes forgo payments because the 30-day window for receiving “all requested documentation” somehow slipped by, I myself have received notes from the insurance company denying coverage for treatments from twelve full months beforehand. It can’t be helped: sometimes it takes twelve months for their computers to process the paperwork and determine that I owe them more money. They like to be thorough. (more…)