Topic Tuesday #147 2015/05/12 "Insurance…"

Insurance...  
A contract whereby, for specified consideration, one party undertakes to compensate the other for a loss relating to a particular subject as a result of the occurrence of designated hazards.

Insurance has been a reason for many of us to start drinking heavily since before there was beer, way back in the Bronze Age about 2700 B.C.. A little known supposition, a bad insurance deal was the impetus to start brewing. Not really... Maybe.

It has become very important to have insurance. Car insurance, home owner’s insurance, health insurance, life insurance, even pet insurance… It seems you can insure anything. Lloyd’s of London offers insurance for models legs, for instance.  Fast fact: Lloyd’s reports €4.1billion (£3.2billion) profit for 2014. That leads me to my own recent experiences with insurance.

After the ACA has taken effect and the insurance companies have been taken to task over their practices, they did not take it laying down. They are a wily bunch of weasels and enforced changes of practices for certain plans that make having insurance a very frustrating experience. I used to have very reasonable co-pays. Should you be reading this in the future – a co-pay was an amount of money that you would pay based on the service, like seeing a primary care doctor or going to an emergency room. Now my plan, which I have through my employer, uses some strange percentage of overall negotiated service rate, which is a number that you have to be an astrologer to make any sense of. To make matters more complicated, they mandated the use of a Heathcare Spending Account, which takes money out of your employers pocket and your pocket and puts it on a credit card, that will be declined for most things that they say you can use it for, and then arbitrarily change what you can use it for and require approval and requests for payment through a website which you have to figure out without any real assistance. I’m an IT guy and used to the web, but even I would have liked to get some tutorials on what was even expected, yes, it is that bad. At this point, I am getting comfortable with the discomfort of this situation. I’m getting my footing and collecting receipts to send in approval scan or faxes… Then…

I got a bill from a specialist that my daughter had to see. It was a consultation. Aparently, this is not covered… or is it? I'm not sure… The total bill to just talk to this specialist for 5 minutes was $705. I was charged $72.82 before we were seen. That was over a month ago. Now I get the bill stating that I owe an additional $291.27… I wonder why. The statement states my insurance company “paid” $340.91 as a “Insurance Contract Allowance”.  So I go to the website for the insurance company…

Bill received by ********* on 04/06/2015 $705.00
Your ******* Member Rate $364.09
Not paid (excluded by plan) $0.00  
Amount paid toward meeting your deductible $364.09  
Amount paid toward your remaining coinsurance $0.00  
Your copay amount $0.00
Your total responsibility: $364.09
Total amount you can expect to pay out of pocket: $364.09

Again, this is not helpful as I don't know why I need to pay anything at all. What is this member rate? That wasn't mentioned anywhere… Yet it is being presented like they have done me a great service by providing me with such negotiation. I doubt very much that this is at all in my best interest. I have no idea what to expect going forward, and I bet neither do you, should you be in my shoes, or if something happened to you.

For the record, I have pretty darn good insurance, or at least that is what was being advertised to me. This is a money shell game and what feels like absolute lies and trickery to get me to pay for everything and not be able to use the insurance that I have been paying for. Insurance companies only make money when they don't have to pay out the money they take in. This is their goal; to not serve you. Once you know that, dealing with them becomes slightly easier to take.

This is the continued state of the healthcare industry in the USA. Nothing is clear and you need a professional translator to tell you what just happened to you. At this point, even with this insurance, you can go headlong into disaster and have no idea if you will be able to pay for anything. I crave single payer simplicity and to not have this Flex Spending Account or Health Reimbursement Account, or both??? Why do I have both? And why are they different? How does any of this work? I need an adult.