Yesterday, in the middle of Hurricane Sandy blasting us with wind, I found a voice mail from a nice lady in Empire Blue Cross Blue Shield's customer service department informing me that my wife's claims for her continuing chemotherapy were being denied because the cancer was a pre-existing condition. The exclusion for such claims runs for a year and then would be covered.
Now the Affordable Health Care Act and NY State Law already make this illegal if you have had insurance up until the time you became covered by Empire, which we did. However, although we had provided evidence of such insurance during the application process, that evidence of insurance went to the sales group in Roanoke, VA and apparently did not make it into the records of the Claims Department somewhere in NY. I think it is in Albany but who really knows in this modern world of the internet.
More nice ladies told me to fax said evidence of insurance, which I had in a file, and then found the fax in the system and advanced it to the next stage. Bottom line, $36,000 of claims that I will have to pay, if Empire does not, are at stake here. Empire has contrived to stall, delay and deny responsibility for payment of this every step of the way. This process started in July and will still take another 60 days for the provider to receive payment.
What if I hadn't saved the proper paperwork after sending it in with the application? What if I were a senior citizen with diminished mental capacity? This is why we need one universal health insurance system. Our old insurance company had all the information and was paying. Our COBRA period ran out and we were forced into the individual health insurance market with a different insurance company. Yes, Empire will eventually pay but only because we had the sense to save some paperwork.
Clearly, Empire has a process here that tries to protect themselves from paying things they do not have to, but in that process, they spend a lot of employees time on things that only delay payment, not prevent it. That imposes unnecessary costs onto the health care system.
Curascripts has higher working capital charges because Empire has not paid them. The Dr's office has higher working capital charges because they have not been paid. Empire has higher operating expense because they need more customer service representatives to speak with people like me and the claim's review process has more people reviewing the same claim multiple times. The next review of this claim will be the 4th one. All these higher expenses are paid by us in higher insurance premiums and provider charges. None of these expenses would occur under a universal health insurance system.
Romney Ryan want to turn Medicare into a private health insurance system that will place the elderly with their reduced mental capacities into a system that is a challenge for younger people to manage. The only result of this will be some of the elderly (and maybe at some point in life, every elderly person) abstaining from health care because they won't know how to manage the insurance coverage and think they have to pay for it, which they cannot afford to. Then they will end up in the hospital when they collapse. It will not reduce the cost of health care for the system because the last 90 days of life are the most expensive and more people will end up in hospitals for their last days.
We have Universal Health Insurance in Medicare and we should have it for people of all ages.
The current system is a nightmare when you get caught up in it.
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