September 27, 2007

Fun with health insurance

Posted in Health care, Medicine, Reproduction at 1:10 pm by The Lizard Queen

As if having a miscarriage weren’t traumatic enough on its own:

Now, on Aug, 29 2007 my husband and I suffered a devastating miscarriage. Being near midnight we went to the ER. The hospital was very compassionate about our loss and was able to get us in quickly and expedited our treatment. The following day I called BCBS and informed them that we had made a visit to the ER, and was told it wasn’t necessary to call them just for ER visits, but only when we are admitted. Believing that BCBS would never make the mistakes at they did the previous and only time we have used our insurance I thought everything would go smoothly. Boy was I wrong!

On, Sep, 21 2007 I received a statement for BCBS that they were denying all of the claim. I called them and asked why they were denying the entire claim, and was told by Jane, “We do not cover ELECTIVE abortions. If you chose to terminate your pregnancy for non-health threatening reasons, BCBS will not cover it.” WTF!!!??? I asked her, “Are you saying that my records state that I had an ELECTIVE abortion, in an ER at 12 o’clock in the morning?” It was then, I think it clicked in Jane’s mind what she was dealing with and told me how sorry she was. I lost my cool and even started crying. I had a miscarriage not an abortion, and being treated in such a condescending way by BCBS really ticked me off. Thinking what an incredibly huge screw up, BCBS will be right on it trying to fix this, well you would be wrong. I was told to call the hospital and have them fax over my records stating I didn’t have an elective abortion. Who the heck can get an elective abortion in a busy ER at 12am, anyway?

And an update, with clarification:

I just got off the phone with the hospital and was told that the claim was not miscoded. The billing clerk told me that the wording clearly stated that I had had a spontaneous miscarriage and not an elective abortion. I was also informed that this is common practice with BCBS of Kansas City to deny miscarriage clams as an “elective abortion.”

On one hand this story leads a number of commenters (and readers, I imagine, myself included) to conclude that universal health insurance would be an improvement over this garbage. Others suggest that what we really need is a more competitive marketplace, with doctors and surgeons (etc.) competing for customers via price wars (because when someone’s cutting me open, cost should totally be more important than the surgeon’s track record [/snark]), and insurance should be more like car insurance, where it’s used for emergencies only, rather than preventative maintenance along with emergencies. Some people said the woman in question obviously should switch insurance companies (like we usually have a choice?); others suggested that she should be sure her policy actually covers expenses related to miscarriage (because it would be acceptable if it didn’t [/snark]).

I don’t really have anything to add; I just wanted to call attention to the story. It’s a fairly extreme example, but as you can see from the comments thread, this kind of thing happens all the time.

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2 Comments »

  1. DavidD said,

    In my experience this is not an extreme example, nor is this a “horrible, horrible story” as the website linked to described it. Amputating the wrong leg is extreme, especially if the right one still has to be amputated. Insisting that life-saving treatment is experimental, when an honest expert says it is not, is extreme. Only feelings were hurt here, assuming BCBS pays what they should eventually. Yes, there’s time wasted, too, but there often is with getting insurance companies or anyone else to pay what a court would say they have to pay.

    I wonder what the reality is regarding how often charges related to spontaneous miscarriages are denied. It’s easy to assume that’s done deliberately to save BCBS money, even though they’re not for profit. Yet is it? Or is it that their computer program that flags possibly uncovered charges is faulty? Or do their procedures deliberately err on the side of denying charges at many levels, not to cheat people, but to put some responsibility for getting it right on the consumer? Many businesses have procedures that only give grease to squeaky wheels. Such a bias may be needed to prevent giving grease where it is not due. Without knowing details, it’s irresponsible to pass judgment on such procedures.

    There are places for a consumer to complain, but what exactly is the complaint here? No insurance company reviews a patients’s entire record before issuing a denial. Nor are there enough sensitive human beings to go around to treat customers perfectly. Why should it be better than this? Why should the world be perfect?

    You’ve summarized well how most used the comments here to push their own prejudice, as if the best health care system is determined by anecdotes. Voters do have some say eventually, but they don’t have to make the system work, to make it so there’s anyone to help you, even someone rude. It’s easy to have fantasies of some other company giving better service at a comparable price. But if those companies are going to ride to the rescue of this damsel in distress, why aren’t they in place now? I’m sure partisans can make up many reasons for that, but they’re still talking about fantasies.

    I doubt there will be any move toward making health care even more of a free market in the next 20 years. This system that voters have been leery to change is pretty free, depending how low a deductible one can afford. That’s why health care spending is so much of the GDP in the US. Maybe one of these Democratic health plans will pass. Maybe the complaints that result from that will be somewhat different from this one, but there certainly will be complaints, and they’ll have at least this element in common with this one, “Don’t you know how sick I was? How dare you?” Or “WTF?” for those inclined toward that phrase. There are many ways that actually being sick is not as important as many people think it is. I’ve been sick a lot, and I’m quite sure of that.

    It’s not just the blogosphere that does this, but all human beings. We want our complaints fixed, for the big picture as well as for ourselves. We’ll use every cognitive distortion in our arsenal to argue why we’re right in this. We all have personal tragedy that few others care about, unless they want to use that story of tragedy as a reason to push their own ideas of how the world should be better. There are always good reasons why the world isn’t better than it is, or it wouldn’t be that way. There is always a big picture beyond any story. I don’t trust anyone who doesn’t care what that big picture is as much as what their own fantasies are about it. Of course, it doesn’t matter whom I trust except for me. Something new will be tried, and people will flock to it or reject it for reasons that aren’t likely to be about what’s best for everyone. I make no difference to that.

    I like my Kaiser HMO. This issue wouldn’t have come up with them. But I know some things they’ve done wrong, things that let some young people die who wouldn’t have where doctors do lots of tests. Those are extreme examples, but people would use those for their arguments just like this one. Distortions come naturally to us. To see things realistically requires much more work, and then such realism may only benefit oneself.

  2. Cara said,

    It’s common practice of BCBS to deny everything but the most obvious and routine treatments.


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