13 November 2007

The Day Blue Cross Decided To Get Their Ass Kicked

Health Care in America is absolutely broken. We’ve heard the stories before. My favorite (not in a good way, but in a “oh my gosh, are you kidding?” way) was of a young girl who could not hear in either of her ears. Her parents tried to get pre-approval for tube surgery, which would most likely completely fix the problem. Her insurance only approved the surgery for one ear, citing that it was not a necessity for life to hear in both.

By no means is my situation nearly as traumatic in the sense that I can hear, I can see and I’m still alive, though according to Blue Cross, that last bit is reason enough to deny me any kind of “insurance.”

I’m sure we all remember when I contracted Dengue Fever. I was in India working on no salary meeting with young people creating social change. By then I had been through three continents and was nearing the end of my whirlwind tour. On that same day a little mosquito decided to make me dinner, I acquired an acute intestinal infection from bacteria-infested water. Not knowing I had Dengue (it’s difficult to detect) the doctor treated my infection and I felt good enough to fly to Thailand. Of course, upon arrival there we all know what happened – I got hospitalized for 5 days.

Upon arrival the billing department called my insurance (Blue Cross Blue Shield), which said I was supposed to pay the bill and then submit it upon return to the US. This was their “standard procedure.” So that’s what my family and I did. We paid up front ($3500) and submitted the bill when I got back.

Yesterday (92 days later) they responded to our payment request. CLAIM DENIED. Why, might you ask? Well, they don’t deem it an “emergency” because my chance of living was greater than my chance of dying. Apparently treating a disease currently experiencing it’s greatest outbreak in history that kills more than 20,000 people a year and is particularly dangerous to non-acclimated westerners that made me lose 10 pounds in 5 days, gave me a fever of 106.8 degrees and caused long-term fatigue, depression and an inability to think isn’t an emergency. Moreover, some doctor sitting in a plushy office who has probably never treated Dengue fever and who earns incentives for denying claims is definitely qualified to make that determination.

The doctor in the hospital all but forced me to admit myself. He checked on me all weekend because he was concerned about my progress. The nurses spent one 12-hour period changing cold packs because my body was burning through them. I was hallucinating. I couldn’t stand up. I felt like someone was pounding on my entire body with a giant hammer. Nope, no emergency.

WHAT THEN, DEAR “HEALTH PROFESSIONALS,” IS AN EMERGENCY? Apparently, had I died, everything would have been covered. To make matters worse, they won’t even count this toward my astronomical $5000 deductible, which my family has a) never met in our lives and b) pays a small fortune for to begin with. The claim has been “thrown out completely,” and again, it took them THREE MONTHS to tell us this.

I ask you, how can one not believe this system is broken? Lets start at the most basic level. Health Care should –at it’s core – have health as it’s primary interest. In our current system, that’s not the case. It is a business, and any business has profit as it’s number one priority. If it didn’t, it wouldn’t be a business! In fact, last year, Blue Cross Blue Shield’s parent company – Wellpoint, Inc. (how ironic is that?) posted a $3.2 billion dollar profit. Health Care costs are up – on average – 70% for consumers and they’re making billions and billions of dollars? What is wrong with this picture? Moreover, America is ranked 17th globally for quality of services in a system that cost billions of dollars more per capita to run. So we’re not making people better and we’re spending more money. Is that even good business?

Bottom line, if our health as individuals (and in turn, a nation; after all, nations are only as strong as their people) are in the hands of people trying to maximize profits, how can they possibly be maximizing our well-being? Healthy people aren’t profitable, and when you can write off every sick claim as a “non-emergency,” ill people aren’t expensive. It’s a win-win for them and a lose-lose for us.

What, then, can we do about it? Demand that your health be left in the hands of people whose primary interest is your well-being. No one should be capitalizing on my ability to live, that young girl’s ability to hear, or my grandfather’s ability to buy medicine. Your first question at the doctor’s office or in a hospital should never be, “how am I going to pay for this?” Health care is at the root of existence, and every human being deserves that right, regardless of age, gender, race or sexual orientation. We’re the wealthiest nation on earth, which leads me to believe we can do it.

As for Blue Cross Blue Shield, Wellpoint, Inc. and their billions of dollars? You have NO IDEA who you’re messing with. I’ve survived Dengue fever. This is going to be like taking candy from a baby. Bring it.

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