Insurance industry works to block access

Having made the decision to have gastric bypass surgery, gotten the support of all the health care providers who kept me alive all these years, and passed the innumerable tests required before the surgery, I felt as though anything else I had to do for the surgery would be easy by comparison.  It had taken me over a year to traverse the pre-op road and now I was finally at surgery’s door – good health awaited me on the other side.  The only issue left to resolve was insurance pre-approval.

Ah how innocent we so often are when we find ourselves about to enter the door marked Insurance Hell.  After all, we tend to reason, we’ve done everything required and the surgery being requested is listed right there in the benefits book as one to which we are entitled.

Step through that door, though, and all innocence and rational thought is completely and irrevocably lost.  Because you have entered the world of professional nay saying, a world of corporate negativity where I can only assume the philosophy is that if they deny you the benefit long enough, you will die and they will have saved themselves a few thousand dollars.

Now, if I’m sounding a bit harsh about health insurance providers – why, that’s exactly how I mean to sound.  Considering the wide palette of health problems I suffered from pre-operatively, I’ve had a lot of experience with them. Little if any of it was positive.

For instance, there are the diabetic supplies that I’ve ordered about once every three months for the past gazillion years. I order from a diabetic supply company. I order strips to test my blood sugar and little lancets to prick my finger.  The order never varies, never changes – four boxes of strips, two canisters to the box, and one box of lancets. And the price rarely changes.  Which is why I am always amazed when the reimbursement check arrives and is always different.

I can only assume the insurance companies are outsourcing these clerical jobs to a place where English is a third or fourth language.  Or maybe literacy is not required to be a claims clerk.  Each time I call to question why they paid me $150 last time but only $25 this time for the same order with the same cost, the explanation gets progressively more creative.

One time I’m told they forgot to look at the line, which says I got four boxes instead of just one. Another time I’m told that they forgot to notice that the boxes contained 100 strips, not 50.  Another time I’m told quite indignantly by the gentleman I’m complaining to that they will not pay $100 for a box of lancets. Well, duh!  On checking, he notes that I was not charged $100 for the lancets. The clerk read the paperwork wrong.

So I guess I shouldn’t have been too surprised when they turned me down for the surgery.  The reasons given ignored all the proof presented that this surgery could potentially not only save my life, but save the insurance company thousands of dollars down the road as I gained better health and stopped using so many of the system’s resources. 

They didn’t care. Didn’t care what my doctors said. Didn’t care about what the medical tests said. Didn’t care what every health professional I saw recommended.  In fact, the rather low-level clerk who kept rejecting the claim didn’t care for any level of argument or reason until he got a letter from my attorney.

Suddenly, all the paperwork that had not been adequate to justify my receiving this benefit became more than adequate.  Two letters from my lawyers, accompanied by no further medical paperwork, and I had my approval. 

As one of the staff at the surgeon’s office commented to me in the midst of this craziness – insurance companies live a culture of corporate denial.  If they deny you long enough, you’ll go away.  Sadly, many people who could benefit from this surgery do just that.  They go away.  And then they die from complications of diseases that could be controlled or arrested through this surgery. How very, very sad.

Next time, the surgery itself.  Also known as the “you can live by broth alone” period.