One insurance horror story among many

A friend of mine is mad as hell: “The red tape is mind-numbing, I get a constant runaround, and every year it is like this. All year long, I receive statements and directives that would take an accountant or attorney to understand. Much of the money we pay them is wasted.” Was my friend talking about IRS and taxes? No, she was lamenting the complexities and arbitrary injustices that pervade our private, for-profit health insurance system. She had just finished her annual arguments with Anthem to retain coverage for her disabled adult daughter, who lives with her. Even the mainstream press now occasionally acknowledges the inordinate inefficiencies of our private health insurance system, but one element is continually left out of the equation. Families, physicians, pharmacists and conscientious small-business owners spend many hours a year monitoring the performance of their insurance carriers, fighting over benefits, making sure that the family is covered during job changes or examining the convoluted options offered by the corporate health insurance giants. Any classical economist will tell you that time is money, but time ordinary citizens must waste is never figured in the already staggering statistics on the inefficiency of our profit-driven health insurance system.

As my friend tells her story, consider how many of you or your friends have comparable stories. “In November, my family received a notice that my daughter’s coverage would be terminated unless her doctor filled out forms saying she was still disabled and could not hold a job. We followed instructions and made sure Anthem received the form. In early December, we received a letter from the customer service rep saying she had been reinstated. Coverage would continue for a year. But in January 2007, we received a letter saying that she was gong to be dropped unless we submitted a new request for continuing coverage and had our doctor certify she was disabled. We knew that we had done this before, but because Anthem has all the power, we went through the same routine. We called again to make sure the form had been received. We received a letter confirming her coverage.

“Nonetheless, on March 27, we received a new cover letter and form from Anthem. The manager of enrollment and billing presented a termination date of April 1, but the due date on the dependent eligibility form was April 10. They wanted us to check some boxes to certify that she was still a dependent. Because it was not clear to me what they were asking, I called them. There was much discussion. Each of the customer representatives was kind and responsive, but Anthem is a system that requires them to wind their way through complex rules and bureaucracies. After a 45-minute conversation with supervisors, this customer service representative said I should fax them the form. By doing so I would meet the April 1 deadline.

“I called Anthem the next day to establish that everything had been received and that my daughter’s coverage was still in place. I requested yet another letter stating so. Instead, another Anthem representative said they had received the fax, but because it needed to go through various committees, it was not clear if my daughter would be approved by April 1. So again I referred to the due date of April 10 on the form they sent. She then went back to talk to someone and returned 45 minutes later to tell me that my daughter was safe.

“A customer service representative then added that we needed to fill out new forms in March because we had failed to check all the appropriate boxes in November. But Anthem had waited until the end of our quarterly billing cycle, after which my daughter would have been terminated, to inform us of a deficient reply on a form received months ago. What if I had been away or sick and did not receive the form in time?

“Anthem is a for-profit business. They collect premiums – we pay $17,000 a year for health insurance – and they make their profit by dumping clients that cost them money and fighting with others over what they cover. I am fortunate that I am at home, healthy, educated and able to spend hours during the work week on the phone, faxing, and arguing with Anthem.”

The private insurance industry scares us with stories of citizens denied care under various universal health care systems like Medicare or the Canadian system. I will have more to say on this charge in subsequent editorials, but what they don’t tell you is that even those financially able to afford private insurance find it covers far less than the publicly financed systems in other major industrial democracies at far higher cost. And for the privilege of whatever coverage they receive, clients must become part-time (unpaid) accountants and attorneys. As my friend says, “no universal system could be more inefficient and demeaning than the present private insurance mess.”

John Buell is a political economist who lives in Southwest Harbor. Readers may contact him at jbuell@acadia.net.