BONE-HEADED HEALTH INSURANCE

Because health insurance is so heavily regulated it is more like a government bureaucracy than a business -- and it shows. Tom Barrett reports below what happened when he needed a CPAP machine to treat his sleep apnea

Health insurance companies are remarkably short-sighted. By and large they refuse to pay for preventative measures that prevent serious, more costly conditions from occurring. (Not all insurance companies are like this, but most are.) Their bureaucratic systems often delay necessary treatments until they become life-threatening. A case in point is my tailor, Mr. Glickstien. He mentioned to me one day many years ago that he had seen blood in his urine. I was a paramedic at that time, and immediately thought of a half-dozen terrible things that could indicate. I advised him to see a doctor right away. He said that his insurance company told him he had to see a general practitioner first, then wait four to six weeks to see a specialist. I told him to go to the emergency room. He did, and was told that if he had waited another day he probably would have died.

Out of the quarter of a million people who read Conservative Truth each week, there are probably thousands of you with similar stories. Mine began when the medical supply company told me that Blue Cross (my insurance company) now required a sleep study before supplying a CPAP machine. Not only that, but Blue Cross only pays for rentals now, and the medical supply company (the only one that is authorized by Blue Cross) does not rent, but only sells CPAP machines! Talk about a catch-22!

Assuming (falsely) that I was dealing with reasonable people, I said that I had already had a sleep study. They countered that it had to be within the last twelve months. I told them I was already suffering from lack of sleep, that I needed the machine now, and that it would take four to six weeks to get a sleep study. They said, "Sorry."

Assuming (falsely) that if I could get past the clerks I might be able to speak with someone more intelligent, I asked for a supervisor. It turned out that she, too, was incapable of any action beyond reading from a prepared script. I had to 1) Get a prescription for a sleep study; 2) Wait a month or more for the study; and 3) Wait for Blue Cross to decide whether they would supply the machine. Never mind the fact that being without the machine could cause serious medical problems that would cost them far more than the machine, and never mind the fact that waiting a month could be life-threatening. That's what the rule book says.

Assuming (falsely) that they would listen to a Medical Doctor, I asked my very busy physician to call Blue Cross, and he was kind enough to do so (thank you, Dr. Liporace, and your wonderful office manager, Jackie). Surely these pencil-necked clerks would not ignore the advice of a trained physician! Wrong again. He told them that sleep apnea is not a condition that reverses itself. If I had it six years ago when they did the first study, I still have it today. He also confirmed that his clinical findings were that I currently have sleep apnea, and that it was imperative that I continue to receive CPAP treatment. He sent them a prescription for the machine, and a Letter of Medical Necessity, confirming that the device was necessary for my health. Their response? "Sorry."

Still believing (falsely) that these people would not be so stupid as to ignore the relative costs, I pointed out that CPAP machines cost between $600 and $800, and that the sleep study would cost between $2500 and $3000. "Why would you want to spend thousands for a sleep study instead of hundreds for a CPAP, just to find out what a Medical Doctor has already told you?" Well, it turns out that they ARE that stupid.

I bring these things up for two reasons. First, America needs to realize that idiotic decisions by insurance companies such as delaying treatment for my tailor friend, or denying less expensive preventative treatments, are causing medical insurance costs to sky-rocket, and in many cases are costing people their lives.

Second, not everyone has the options I have. I will purchase my own CPAP machine, and then spend whatever time it takes to force Blue Cross to reimburse me, because I cannot afford to go any longer without therapy. But there are hundreds of thousands of people in this country who don't have that option. They pay the unconscionable rates these companies charge, and can't afford to pay extra for necessary treatments when they are arbitrarily denied by their insurance companies.

Enough about insurance companies. You can expect to see more in this column about the abuses of these companies who advertise about how much they care about us, but who treat us like we are beggars when we expect the treatment we pay for. Let me end by encouraging you to be aware of the problem of sleep apnea.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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