Health Insurance and Profits: Capitalism is not to blame

Today I read this article in the NY Times:

http://www.nytimes.com/2013/01/09/business/health-care-and-pursuit-of-profit-make-a-poor-mix.html?pagewanted=all

For those who read this blog and The Malformation of Health Care book http://www.amazon.com/dp/B009V37CXU  you already understand my position on what this article says (the author is preaching to the choir).

I find it fascinating that no matter how many discussions, articles, programs, books, take on this topic; these companies still have the audacity to continue acting in bad faith.

What will it take for incredibly high powered, well lobbied, excessively wealthy companies to become accountable for bad practices?

I'm sickened to say, probably "nothing".

Despite the claim that corporations are people, corporations (especially on this high of a financial level) do not have an internal moral compass. Most people who work for these companies are at the mercy of this corrupt system just as much as the customers who pay their premiums each month in hopes their policy will cover them should tragedy strike.

This is not capitalism. This is greed.

The reason I say this is because I know what the ideals of capitalism are, I grew up on them. My family owned a small hardware store for over 100 years. The reason the company lasted for 100 years was because of the pride taken in our services and products. We didn't force anyone to shop at our store, but we gained loyal customers, based on our integrity.

We offered competitive prices and guaranteed our products and our work. If a customer came in to the store and said a product was faulty and we didn't either exchange the product or fix the issue, we would have been run out of town. No customer would have shopped with us.

When a health insurance customer comes to the provider with a problem, many times they are ignored, avoided, or told of a previously undisclosed "loophole" that frees the insurance from all coverage obligation.

Capitalism only works when those servicing the population understand that first and foremost they are performing a service for the community. Profits come when that service is performed well. If that service is performed poorly, profits should be reflected.

That is capitalism.

That is not what is going on currently within our health insurance system.

Denial Letters Without Using Facts

Earlier this year I posted a blog with a denial letter I received stating I was denied coverage, because.
http://themalformationofhealthcare.blogspot.com/2012/08/denial-because.html

No, I didn't forget to finish the above sentence. The denial letter I received said I was denied coverage "because." No further explanation.

It turned out the reason I received the denial was because of an inter-insurance-company problem having nothing to do with me. So when the insurance company didn't pay my claim, they had no reason for why it was denied, and therefore left the section blank. Leaving me to panic, call them, and wait until they cleared up their error and pay the invoice prior to me ending up in collections for something that should have been covered through insurance.

Ready for something to top not giving a reason for a denial.....

Drum Roll Please.....

Yesterday, the insurance policy I have held since I had to stop working due to my arteriovenous malformation and chronic myelogenous leukemia sent me a letter listing off several reasons why they have decided to stop honoring their obligation to my claim. They included not hearing back from my doctor (although my doctors name was spelled completely incorrectly and I can only wonder if she even received the documents she was asked to fill out). Partial information from a report done by a doctor who in a video taped interview stated he did not treat either condition I have. Video taped surveillance showing me go into a local business for 3 hours (without mentioning it was a dental office)...And the piece de resistance....

 because my oncologist informed the company that I was in complete remission from AML.

You can imagine my relief to hear I was in complete remission from a condition I was never diagnosed with.

Here's the portion of the letter:

Yes, this denial letter stooped so low as to deny my claim using completely false information.

AML is Acute Myeloid Leukemia. It is a really terrible blood cancer that is difficult to control. I have known two young adults who have battled this disease. One survived it and one did not.  AML is treated with aggressive traditional chemotherapy and often a bone marrow transplant.

I have Chronic Myelogenous Leukemia-- a completely separate condition that currently has no proven "cure" outside of a bone marrow transplant. Fortunately for me, as long as I take a daily chemotherapy pill my chronic leukemia is kept at bay in the body. It is not a traditional "remission" as suggested by this letter. It is a conditional cytogenetic response to a daily chemotherapy drug.

I sent in the appeal letter today correcting their misinformation and requesting my policy to be reinstated. Should this company deny the claim a second time my only recourse is to hire an attorney.

Health Care and Religious Freedom

Can we stop all the shrouded discussion on this topic and call it what it is? The reason religious freedom is being brought up with regards to the new health care law is because of the issues of women's fertility and money. With that I mean contraception, abortion, and the cost to care for the sick.

This is article I read this morning: http://firstread.nbcnews.com/_news/2012/11/26/15456408-supreme-court-opens-door-to-universitys-health-care-challenge?lite

In the article Liberty University is contesting the individual mandate for health insurance due to their belief that because most health care policies allow for abortion and contraception Liberty University's religious freedom is being trampled on (fertility). They are also contesting the section of the bill that states employers must provide health insurance or pay a penalty (money).

You might be wondering why this is coming up again since the individual mandate issue was already discussed and decided on earlier this year by the Supreme Court. The answer is there will always be someone, or a group of someones, who look for ways around decisions. I'm not saying this from a liberal or conservative perspective, I'm saying it from a historical perspective. Our country was built on disagreements and loopholes (example- all men are created equal, but slavery is fine).

The Supreme Court's decision about the individual mandate, earlier this year, was in relation to state's rights.  Liberty University is a private institution and often times private institutions do not have to adhere to certain state or federal laws. Loophole.

I suppose what bothers me about what Liberty University is doing here really comes down to the issue of money being wrapped up in a religious cause. When I think about spiritual principles in health care, I think about caring for the sick, and the poor. I don't think about legal battles to deny coverage for the sick and the poor using convenient loopholes in man made policies.

I feel like there is a disconnect between what the law is intending to do and some religious reaction to it.

Here's an example of what that disconnect can do (note: this happened outside of the United States).

 http://www.reuters.com/article/2012/11/23/ireland-abortion-idUSL5E8MN7YM20121123

A woman visiting Ireland died of blood poising after being denied an abortion when she was already miscarrying. There was no saving the fetus at the point when the woman asked for the termination. However, because of Ireland's anti-abortion law, she was denied the medical assistance necessary. The miscarriage lasted for three days, which presumably caused her body to become septic and she passed away. Abortion in this case would have been used not for the ending of a life, but the saving of life. Which is why I become frustrated when some believe abortion is a cut and dried issue.

We need to reconnect to the human side of health care. If we boycott coverage for medical procedures and people on the premise of religious freedom and an otherwise healthy individual dies because of that boycott--- who is at fault?

I would argue unexamined principles. When we fight so hard against something often times we become blind to the full picture. We focus so intently on the rabbit, that we miss the lion about to pounce.

Thanksgiving for Non-Profit Groups!

Thanksgiving is this week and I'd like to take a moment to thank all of the advocacy groups out there dedicated to helping those struggling with health care.

Groups like

The Patient Advocate Foundation:  http://www.patientadvocate.org/about.php?p=901 
that has an online web-chat to answer specific questions a patient may have regarding insurance access, job retention, and medical debt.

P.S.I/ Patient Services Incorporated: https://www.patientservicesinc.org/how-we-help/default.aspx
that offers co-pay assistance to some patients on extremely expensive medications.

Sy's Fund: http://sysfund.org/
that encourages young adults battling cancer to also pursue their artistic/ life goals outside of their health  battle.



There are so many wonderful organizations out there that I would be remiss to try and name them all. However, I am happy to update this post with additional references if you simply comment below with the name of the organization and what it focuses on.



Blessings to you and yours during this holiday season!

On A Personal Note

Many of you know that there are four states (Washington, Maryland, Maine, and Minnesota) that have referendums or initiatives on the election ballot for November regarding equality. 

I usually keep this blog relatively specific to the public situations of health care. 

This year has been a real journey for me, however. 

I think I've been afraid to speak up about my sexuality and spirituality where backlash was potential, for a long time. Speaking about my health care journey at the Seattle Women's Choir Equality rallies and shows was easy because the supporters outnum

bered anyone who might disagree. 

Playing my music at GLBT affirming clubs and churches was never a problem, because everyone understood. This year particularly I've had to make some choices. I was conflicted about discussing sexuality and spirituality in my book about health care, even though both are huge parts of my life. I ultimately decided I needed to be honest and tell it all. I'm not ashamed to be a spiritual, faithful, believer in God. It's not a contradiction to love and believe. This year has been filled with baby steps that I didn't even realize I needed to take.

I thought I was "out" but I was only "safely out." Sometimes we have to speak up even when we're uncomfortable, even if we're scared--- because the only way things can be better for all people is when individuals come forward and tell the truth. Domestic Partnerships are separate and not equal in health care and many other ways. I know this, not from research, but from my own life and the lives of my friends.

These votes are not about my relationship. They are about all relationships. It's hard to know what life would be like to not have to fight for something like this. It's hard to know what it would feel like to not have groups dedicated to making sure others look at me as an abomination. It's hard to know what it would be like to meet someone, fall in love, and simply start planning a wedding with no legal barriers.

I'm less thinking about myself and more thinking about the children who come after me. Wouldn't it be nice if they never had to feel like their love was "less than." Wouldn't it be nice if everyone understood that God is love, and therefore real love, can never be "less than".

Link to my speech about Health Care and Referendum 74

http://www.youtube.com/watch?v=au-dXE7L6jQ

Link to something else that touches my heart:
http://www.youtube.com/watch?v=hlVBg7_08n0&feature=share

The Power of Your Words: Phonebanking

We aren't all lucky enough to find a public platform to share our personal experiences with large audiences.... however...

This week has been eye opening for me.

I've been blessed several times this past month to talk a bit about my health care journey in conjunction with the Seattle Women's Chorus during some of their performances. Due to this exposure, I've been freely given the immediate feedback of kind faces, and gentle hands placed on my arm as soft words thanked me for my courage to speak up.

I like face to face interactions. I like the power they have. I like the energy in the room.

Then last night a friend told me a story about phonebanking.

I will 100% admit I'm uncomfortable with phonebanking. Despite the good I've been told it does, I've always looked at it similarly to telemarketing---which actually caused me to disconnect my house phone awhile back.

I'm bugged when I get political phone calls on my cell phone where someone asks me if I have time to talk and then asks me one question. When I answer the question in a way they weren't hoping for, they don't continue the dialogue they simply say thank you and hang up. What is the point of that?

A little background before I begin the story:

My friend now lives in a wonderfully diverse urban setting. Her entire family, however, lives in small town rural America. From the stories she's told me, many of that family just simply hasn't been exposed to as much of the diversity that my friend has, and this has caused frustration, confusion, and even all out angry fights.

There is nothing wrong with these people. There is nothing evil about these people. There is nothing hateful about these people. It is simply a matter of exposure. When you never meet an actual person that falls into a category others tend to criticize, how would you know anything other than the critical words?

As my friend was at work on Friday she received a phone call from her mother saying she had made a decision to support a local referendum. A referendum my friend was certain would not be supported by anyone in her family. This, quite frankly, FLOORED my friend.

She immediately called her mother to find out what had changed.

Turns out, another small town community member was a part of phone bank that day and happened to be the one who called my friend's mom. He was polite and genuine and simply had a heartfelt discussion with this woman.

After the call ended, my friend's mom changed her mind on the referendum... because she took the time to really think about her vote. She realized how much power her vote had in the lives of "others" she's never even met.

While I am glad to be able to share my story with the crowds of people I've spoken to, I've really had more of a "preaching to the choir" effect. The people in the audiences do have reach to others, but mostly those listening already understand my point of view.

This one phone banking person, on the other hand,  was able to reach the unreachable.....

now that's saying something.

Denial Because...

I couldn't make this letter up if I wanted to. Therefore, I decided to post it for you.

If you read the letter you will see that the insurance company will not pay for the prior authorized visit to a doctor I went to "because"

Sincerely,

Claims Department

That's right, they didn't say why, they just said "because."

It's okay to laugh. I did after I got over the shock of getting a denial letter for a prior authorized appointment.

The company is based in Florida and if this was my first rodeo with an insurance company in Florida I might think "oops, someone sent this by mistake." However, attached to this notice of denial is also my EOB (explanation of benefits) reiterating the fact that my insurance company (that I faithfully pay every month) will indeed not cover this appointment they authorized me to go to.

The truth of the matter is Florida has lax regulations on insurance companies. They're not the only state with these lax regulations, but you have to question why so many of these companies avoiding their obligations are based in certain states and not in others.

In general American's don't like "regulations"--- there is a fear that "regulations" will lead to a communist system. I think that's a bit of extreme thinking and there is no way our country would move briskly to a non-capitalist society based on regulations for companies who are clearly not working for the best interest of their consumers.

All regulation means (in this case) is the loopholes, games, and tricks these companies play to gain the most profits based on denying coverage would be accountable to review. I personally think that would only improve our health care system.

Or maybe we will all begin to accept letters without question that say "We will not cover your care, because."

Passion for Purpose

As many of you know, last year I connected with a group of people on a mission. The mission was to discover our passions and how they could translate into purpose.

I have many passions. I am passionate about music, I am passionate about my family, I am passionate about making a difference. Before this journey I would not say I was "passionate" about health care. I was just struggling to work through a system that was not easy. The best way to describe my relationship with health care was persistence, but not passion.

However, I had a fire in my stomach for social justice and this system stoked that fire more and more. I believe we are given recurring themes in our lives that build and shape us to become warriors for good, if we're willing to accept the challenge.

Over this last year I have accepted my desire to help others so they may not have to struggle the way I did. I have recognized how that ties into health care, and how ultimately that really is the clearest passion for purpose path I've been given.

I am educating myself daily to try and build my understanding of this passion. I am recognizing there is no "one right answer." I am learning from people I agree with and those I disagree with.

Passion for purpose is not an easy road--- but so far it is rewarding.

What unexpected passions do you have? How can you use them for a greater purpose?

Kickstarter and The Malformation of Health Care

Have you thought about ways you want to change the world?

This blog and its facebook group counterpart ( https://www.facebook.com/groups/352009698155992/)

works diligently to try and do just that.  

I've found that the more we tell our stories about pivotal life experiences, the more others learn and the more positive change we can create!

With this in mind I have decided to launch a kickstarter campaign to further share my health care journey. In my book, I discuss some of the pitfalls in the American health care system, I offer tips on struggling through the system, and offer encouragement for others to use their experiences to help create positive effective change in our world.

Please take the time to view my kickstarter pitch here:

http://www.kickstarter.com/projects/1139799717/the-malformation-of-health-care

If it strikes a chord with you, please share it so the campaign will have the potential of going viral and doing the most good.

Together we can do incredible things!!! Here's a small step :) 

Fighting Against Health Care... And Fighting For????

Am I the only one frustrated with politicians fighting against health care continuously?

I understand those who believe the Affordable Care Act does not go far enough. I even understand those who feel the Affordable Care Act has too much government involvement. What I do not understand is the lack of other suggestions that may spark a dialogue to help improve our health care system.

Today the House of Representatives voted to repeal The Affordable Care Act... for the 33rd time. Normally at this point I would say "that's an exaggeration, it wasn't really 33, it was____." Unfortunately, there is no exaggeration in this case. On 33 separate occasions the House has wasted valuable time and money to beat the proverbial dead horse.

This latest repeal effort (again) has no chance of passing through the Senate to arrive on the presidents desk. Even if the president did see this repeal, he would not sign it. From every news source I've seen today, the general consensus is this was yet another political stunt to avoid fighting FOR something helpful... perhaps the Jobs Bill... (just a suggestion).

Rather than grandstanding, can you imagine the positive accomplishments these very powerful people could instead be celebrating?

Fine.

If everyone is so hung up on this health care law that no other bill can be considered, why not present positive suggestions to improve the bill? Fight for clear and specific ways to be more efficient and offer more security for the common man/woman. Don't junk the good and the bad of the law, work on it! Be the champion of a well cared for healthy society.

This bill, no doubt, will be massaged over the decades just as Medicare and Social Security were. Many great minds have worked on those projects. I challenge the members of the current House who continue to fight against health care to instead make their mark as the newest great minds who history will remember for helping a nation heal its people.

Supreme Court Health Care Decision

At the end of this month the SCOTUS (Supreme Court of the United States. for those who may have not seen the acronym before) will be deciding on the Affordable Health Care Law's mandate to require every US citizen to buy health insurance.

Is it wrong to say I'm conflicted?

In one sense the mandate must stand because it will help fund all of the positive features of the new law. People have been struggling with insurance for many years now (in my opinion more so since health insurance companies were allowed to become publicly traded businesses). These positive features in the law really should not have been something "new" or a "kindness extended" to those purchasing policies. These are common sense practices that slowly were removed from policy holders over years. The law attempts to partially regulate an industry that has derailed with greed. Having this law remain in tact will send a signal to the insurance companies that they are now being monitored and can not simply deny someone's treatment to improve profits for their investors and pay enormous bonuses to medical directors who deny coverage and save the company the most money. There are at least some checks and balances. Any change is better than no change.

In the other sense, I'm completely disgusted that the law does not have a public option. The mandate to purchase policies from private insurance companies (who no doubt will find ways around following the law as it is intended) gives these publicly traded companies more business than they deserve. Capitalism was founded on the basis of providing the best products at the best prices so as to compete for buyers. When a whole system is set up with good intentions to do the best for clients, capitalism works. Unfortunately, this is not what we are dealing with in this instance. One health insurer is not any better or worse than any other health insurer. Some policies that your employer may set up have fantastic coverage, but that changes from employer to employer, from access to access.  The publicly traded insurance companies, from my vantage point, seem to be in cahoots. Each is offering less and less while charging more and more. There is no real competition. There is no real capitalism. They are not worried about the consumers, they are worried about the investors.

I understand the law would not have passed at all with a public option because the well paid lobbyists for insurance companies and their interests worked over time at convincing voters in congress that a public option equalled government interfering with capitalism. I'm bothered that some of our congressmen and women fell for it. I'm bothered that they didn't have the bravery to speak to all types of their constituents and see the problems before voting. I'm grieved to know these companies have had months to find loop holes so no matter what the outcome of the Supreme Court decision, policy holders will still suffer.

I am conflicted because the point of the law was to provide positive consistency of care for everyone in this country, and financial interests have corrupted that good will.

There is nothing socialistic about wanting capitalism to work without corruption.



 

Mental Health or Mental Illness?

Yesterday morning in Seattle a man shot and killed several people in two different locations. When he was found, several hours later, walking down the street and confronted by police, he then shot himself. According to ABC news, his brother was interviewed after the incident and said it was "no surprise" to his family and friends. Apparently the shooter was struggling with mental-health issues.

The reason I'm writing about this today is because I live in Seattle and yesterday was terrifying. No one knew where, or who this man was. They didn't know his motivation. They didn't know if there was more than one person involved. This was a completely random incident.

The question for me is if so many people were aware of this man struggling with mental health, what were the reasons behind him not getting the medical help he needed?

As a country we tend to brush off mental health issues. I don't know if it's because of shame, or societal expectations.  I don't know if it has gotten worse over the years, or if we just hear about it more now thanks to the media. What I do know is there are entirely too many people with mental illness who are not being treated.

The National Collation for the Homeless published a study showing mental illness in the top three causes for homelessness. I don't believe this particular shooter in Seattle was homeless. However, according to another story from Miami this week about a naked cannibal eating a man's face, that man was homeless and drug addicted which may mean he also was dealing with some mental illness. My point is, mental illness happens in every category of people, and not every category of people has the coverage to be treated for it.

Homeless people have little access to health care. Part time employees have little access to health care. Full time contractors, small business workers, some retail employees, all have little access to health care.  That's a problem.

Here's a bigger problem, most health insurance policies don't cover very well for mental health. Premium policies may have catastrophic coverage up to a million dollars if a person finds him or herself in a terrible accident. However, in the same policy they may only  cover (with a high co-pay) a few sessions of therapy for the mentally ill. Considering the cost of antipsychotic drugs, the policy's coverage might be lacking there as well.

My frustration is when a mentally ill person who has not been adequately treated, causes the catastrophic coverage to kick in for someone else.  Wouldn't it make more sense to not cut corners on mental health coverage and potentially avoid a catastrophic incident? Mental health is not separate from physical health and it should not be treated separately.