By now you all notice that this time each year I tend to stick to posts about our Yes, Virginia efforts. I like staying in that headspace, reveling in tinsel draped feelings and keeping my heart's twinkle lights glowing. Straying into any of the news o' the day is just the quickest way to douse all of that. So I take a hair-on-fire hiatus as it were.
But after a lot of thought, some thoughts just need to find their way to the keyboard today.
Yesterday's early morning murder of United Healthcare CEO Brian Thompson in New York City has captured the country's attention since it hit the wires. (That it was caught on video? Oof.) What it has also captured, however, is the long simmering anger held by an entire nation against an entire industry.
And I will not sit here and be a hypocrite. I am one of the ire filled that takes a very dim view of the insurance industry and the powers-that-be, like Thompson, that rake in tens of millions in salaries each year while denying the claims of those whose premiums fund said outrageous paychecks.
And I know I am not alone in what my initial thoughts were: The gunman was denied needed coverage. The gunman lost a loved one to denied claims. The gunman has a loved one who is dying from being denied coverage.
Now, I stress that none of those things has been verified and the killer is still at large. I also state unequivocally that murder is not an acceptable form of protest. Or payback. But in the final wash, if I am even close on what the motivations were, then I have to echo the long standing Chris Rock bit about OJ Simpson, "I'm not saying he should have killed her ... but I understand."
That is not approval, tacit or direct. That is not admiration for what happened. And it certainly is not some desire to see open season declared on all healthcare CEOs. Far from it. But to sit here typing and not admit to seeing the easily connected dots between wholesale suffering, a 33% rate of denied claims, and a desire to hurt someone? Well, again, I hate hypocrisy. So yes, I see it.
United Healthcare is, as seen in the graphic making the rounds since yesterday, holder of the title of highest percentage of denied claims. A full 33% of health insurance claims are kicked back with a big fat NO. That UHC, like so many companies, use AI to make determinations resulting in over 90% being inaccurately denied? I'm not sure which is worse, that doctors and hospitals submit these claims on behalf of their patients and a real human being is not on the receiving end. Or the fact that UHC knew about the 92% error rate and stuck with the program. Reason? Only about .2% of people appeal their denials, so why fix what is so broken it nicely pads your bottom line for stockholders?
If you're lucky in this country you have health insurance. The majority who do obtain it through their employer. Others have managed to find and pay for insurance through the Affordable Care Act (yes, Obamacare, for you Trump loving dipshits who ran to Google after the election asking that very question along with Can I change my vote?) And private insurance is also an option people may try to access. And they are all costly. They just are. That word is all relative, I know that. What comes out of my husband's paycheck each month for the two of us is manageable for us. It would also make it difficult for other people to put gas in their cars or food in their stomachs.
We don't have healthcare in this country. The sad fact is that we have businesscare. The bottom line of health insurance companies is not being there when you need to use your insurance. It's being there for their shareholders, for Wall Street. Which is why so many claims are denied.
It is all so gallingly egregious. A doctor submits a claim or a request for a patient for a drug, a treatment, a surgery. A DOCTOR who knows his patient's needs, disease, pain, odds. And what happens in 6% to 33% of these cases (see chart)? Denied. Then a whole denied dance has to begin as your doctor, his staff, YOU appeal to the insurance company to reconsider the request, to actually have a human being look at the provided backup, charts, diagnosis, and prior treatments. And on and on it goes.
I sit here right now looking at one such denial here on my desk. Without going into copious details, my spouse needs a certain medication. Other options have been tried. Tests have been run that have eliminated various avenues. He has been taking said medication for a couple months now, samples provided by his doctor as this whole submission process has been working its way through the system. And the drug has been working beautifully for him. But samples are free. With insurance? Roughly $300 per month. Without? $5,000.
So, submitted by a specialist who knows my husband's particulars, has been the one who has been treating him, has run the required tests for other options, and who now has had their request denied?
Because FUCK. Seriously, to call the ream of papers gobbledygook is generous. But more on this later...
Yesterday, on the heels of the shooting, came the absurd news that Blue Cross in Connecticut, New York and Missouri just announced that if your surgery runs over the allotted time, they will not pay for the overtime anesthesia. What in the actual ...??? Seriously, so you're laying there, under the knife and under the sweet protection from pain and awareness that anesthesia is there for, and a complication, a delay, a whatever ends up taking more time than some AI bot has decided your spleenectopotomoplasty should take. So what's the answer BCBS (that BS should stand for bullshit)? Let the patient wake up with their entrails laying about? Give them a leather strap to bite down on while they are sutured shut? Or just let them go to sleep knowing they may wake up bankrupted by your need to keep your stockholders $edated? (This afternoon, after being publicly pilloried by anesthesiologists, surgeons, and the public at large, they reversed their decision.)
It is also notable that UHC has been one of the biggest in lobbying efforts against universal healthcare in this country. (Over $100 million to date.)
Stories of healthcare insurance denials are everywhere and they will only proliferate as more details come out about the shooter and motives. Shell casings were found at the scene with the words "deny," "depose," and "defend" on them - words that investigators acknowledge may be in reference to a book about the industry called Delay, Deny, Defend by Jay Feinman - a book that is about the strategy of the insurance companies and their entire financial ethos being tied to dragging out claims as long as possible and what a consumer can do.
Stories are heartless.
Anti-nausea drugs denied for a child going through chemotherapy.
An insurer’s letter was sent directly to a newborn child denying coverage for his fourth day in a neonatal intensive-care unit. “You are drinking from a bottle,” the denial notification said, and “you are breathing on your own.”
A college-age young man, suffering a life-threatening anaphylactic allergic reaction, was saved by epinephrine shots and steroids administered intravenously in a hospital emergency room. His mother, utterly relieved by that news, was less pleased to be informed by the family’s insurer that the treatment was “not medically necessary.”
A Los Angeles man said he was “shocked” when payment was denied for a heart procedure to treat an arrhythmia, which had caused him to faint with a heart rate of 300 beats per minute. After all, he had the insurer’s preapproval for the expensive ($143,206) intervention. More confusing still, the denial letter said the claim had been rejected because he had “asked for coverage for injections into nerves in your spine” (he hadn’t) that were “not medically needed.”
The stories are endless. And unforgiveable.
On my home front, we are in a new waiting room. As it turns out, a very recent occurrence makes it now impossible for my husband to take the drug that was working so well, but that they denied. Now we wait while his doctor goes back to our insurance company requesting coverage for his last option. And yes, it's fucking expensive. Even with insurance. Without? I can't mentally go there right now. While we could tighten our belts and swing it, so very many people would simply be left to a life of suffering. I just do not understand this country that allows people to suffer, to die even, for the mere sin of not being wealthy.
Brian Thompson should not have been murdered. I reiterate that. But the reaction to his death should send a message to the entire health insurance industry, especially the ones at the top of the pyramid. People will only be pushed so far. A person's healthcare is not a game. A loved one's cancer is not to be left up to some algorithm. A child's life should not be in the hands of someone with less than zero healthcare experience. My husband's pain is not something to be blown off by a bot.
I am very sorry for his family who loved him and will miss him. But my true thoughts and prayers will stay in network with the 100 million Americans currently saddled by medical debt, and the millions more who are denied their paid for, necessary, and life saving coverage every year.
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Now, excuse me while I get back to elfing and trying to plug back in the twinkle lights in my soul.
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