Thursday, March 20, 2008

Health Insurer Tales


I received three letters from my health insurer yesterday. One informed me that they were requesting my medical records from my doctor. Another informed me that they were requesting my records from Wal-Mart Pharmacy. The third letter was the one that really made me angry. They included a form asking me to fill in all the docs, hospitals, pharmacies or any provider that treated or consulted with me in the last 5 years. Here's the line I liked the best: "Although medical information may have been provided at the time of your application, please take this opportunity to send us a complete listing including any additional information not previously disclosed". First, they know darn well they asked for medical information on my application. In my case, I had to go back 10 years! I was really upset at the implication that I was dishonest in my application. Their tone sounds like "tell us now before we find out".

What's all this about? Approximately $22! I went to my doctor in February. My goal was to re-establish the relationship (he didn't know I had moved back from New Hampshire), get a refill of my cholesterol medicine, and to ask him about the pain in my hands. I have pain in both hands that prevents me from opening jars. It makes opening potato chip bags painful (of course, one could argue that not being able to open potato chip bags is a benefit). The doc prescribed Clorindin / Sulindac. I went to Wal-Mart pharmacy and got a 30 day supply. Based on my condition, the doc said that these pills will help and may even put the disease in remission!

Now, my insurance carrier is going to spend hundreds, perhaps thousands of dollars to try and determine if I had this condition prior to being insured. Because, if it can be proven, then they don't have to cover anything related to it for a year. I'm sure they think it's not just $22, but that this condition will lead to more. Mind you, they aren't going to have to actually pay me a penny - I have a $5000 deductible!!! But, the idea of applying anything to my deductible seems against their rules. None of my doctor visits to check up on my cholesterol are covered - because I had high cholesterol prior to being insured. So much for being proactive - not rewarded.

I was much angrier yesterday. But, this is their business model. And, as I've stated in earlier posts, the for-profit insurance approach to health care is a bad fit. It works for cars and homes, but not healthcare.

As a side note, not that the insurance people will ever ask or care, the pills have done wonders. My hands do not hurt. I can open things without pain. I can type this post without pain. The pills do have some side effects, but I'm putting up with the inconvenience (I'm going to spare you the details) because the elimination of the hand pain is worth it. I really hope when the 30 day supply is done that the pain continues to stay away.

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