I’ll tell you what, I’m a healthy guy. And thank God I am, because it is a damn nightmare dealing with insurance companies.
I get insurance through one of the companies I freelance with (I’m in the system as a part-time employee). It’s a good deal, because I’m only doing about 20 hours of work for them a week. Very kind of them to offer me insurance. It comes out of my paycheck, of course, but it’s still a lot cheaper than buying it on my own.
I discovered recently that they switched their plans. I mean, I knew they were switching their plans … we got extensive emails about it when it was happening. The cost of healthcare had gone way up, they said, and they could no longer afford the kinds of plans we were on before. I paid little attention, because like I said, I don’t really need to use my health insurance that often.
Well, I didn’t need to use my health insurance that often. One thing I’ve been getting into since I moved to California is acupuncture. I’ve had this pain in my shoulder for years that I never had professionally examined. Some time last fall I figured, all right, I’ve finally got health insurance, why don’t I use it? So I started going to this acupuncturist who told me I had some scar tissue built up that needed to be worked out. Things were going great … my shoulder felt better than it had in years. The acupuncturist called my insurance company – no problem, they said, as long as it was related to a physical ailment, I could get all the acupuncture I needed.
Then in April, my plan switched, and all of a sudden that unlimited acupuncture turned into no acupuncture ever because, after all, it’s not really medicine. Of course, like a fool, I didn’t investigate all the new plan benefits. So I went to the provider’s website to see just what was covered by my new plan. The only info they had available was a 2 page pamphlet with 3 different categories – doctor’s visits, inpatient, and outpatient. Each of these three things was limited to 5 visits. So, for instance, if I get in a car accident and lose all sense of feeling in my legs, I have 5 tries to get it back.
I thought to myself … this can’t be right. What if people have real problems that can’t be fixed within 5 sessions? I called the insurance provider and said, “hey, so, I’d like to get a big book that clearly explains all my benefits to me, please.” The woman I spoke with directed me toward the 2 page pamphlet. “Ok,” I said, “well, this doesn’t tell me much. For instance, what if I need to get psychological counseling? How many visits am I allowed?” “Outpatient services, 5 visits,” she replies. “Okay,” I said, “but what if I’m super crazy?” “Just a second,” she says. She comes back and says, “if you’re diagnosed with a serious mental illness, such as bipolar disorder or schizophrenia, you are allowed unlimited visits.” “Great!” I answered. “Now, can you please send me the book that lists all of those exceptions?” “There is no book,” she said. “But if you want to know if something’s covered, call me and I’ll tell you.”
Now, I ask you … does this seem right? That the only way I can find out what services my insurance provides me with is to call the provider? The provider that makes its money denying people benefits? I mean, everyone knows our healthcare system sucks. I’m not blowing the lid off some hitherto unknown phenomenon. I guess I just didn’t realize we’re in such a bad state that people who have health insurance are only allowed to visit the doctor 5 more times than people who do not have health insurance.