Single Health Payer, with the emphasis on the PAYER

This past year, I switched from employer-offered health insurance to a single payer private health insurance. What an eye opening experience that was. For anyone who is on the fence about the healthcare debate, or thinks that universal healthcare is Satan incarnate and that the future is single payer, guess again.

My private single payer health insurance wouldn’t cover a routine physical. They claimed that because the primary diagnosis (acid reflux) was “pre-existing,” they were under no obligation to cover this doctor visit or any prescriptions that coincide with this condition for the next 12 months.

I was diagnosed with acid reflux when I was 16, and the doctor who coded the claim was a new doctor of mine; but that doesn’t matter. See, the nasty little secret of single payer insurance policies, is that they want me to pay the premiums, but not receive the coverage. I paid over $900 in premiums up to that point. The office visit, including labs, cost them over $700. They would’ve only made a $200 profit.

To add lunacy to lunacy, my insurance company covered the labs, stating that they were not due to a pre-existing condition (the standard blood and urine analysis), but that the actual doctor’s office visit was due to said condition. So I have to pay an addition $100 (which is the standard emergency room charge) to my $30 co-pay.

$130 on top of paying $110 a month for my single payer health insurance.

I started to worry that if they could deny any future claims I sent them. So I did a little research and found out that yes they can!.

The best quote is the second paragraph of that article:

“The legal basis for rescission is that when you sign an insurance application, you are warranting that the information on the application is true; if it turns out not to be true, the insurer can get out of your insurance contract. It’s particularly nasty in practice because the insurer does not immediately investigate your application to determine if it is accurate before selling you the policy (that would be impractically expensive); instead, the insurer waits – years, in many cases – until you actually need expensive health care, and then does the investigation, which at that point is worth it because of the payments the insurer could potentially avoid. Also, you can lose your coverage for innocent mistakes, which are easy to make since the application form asks you if you have ever seen a doctor for any one of a long list of medical conditions that you are certain not to recognize or understand. (In a Congressional hearing, the CEO of a health insurer admitted that he did not know what several of the conditions listed on his company’s application were.)”

Having worked in medical billing for almost 3 years, I can tell you that insurance companies, whether they are auto or health, will look for any reason not to pay a claim. From little loop holes built into their contracts to the font being “illegible” on the government issued document (not kidding on that one).

The current healthcare system of this country is not working for the benefit of the American citizen: it is solely benefiting giant medical corporations, insurance, hospital or otherwise. And before you start espousing that America has the best healthcare system in the world, we were ranked 37th in healthcare quality by the World Health Organization.

But we ranked 1st in cost per person. So yes, we are number one…the number one sucker.