Re "Patients pay more, get less -- if they're lucky," Oct. 21
The Times' article should open a lot of eyes. The focus of your inquiries needs to broaden, however. Too many healthy people with group coverage are unaware of the risks that lurk just under the surface of our managed healthcare system. Although it's true that those who are fortunate enough to have group policies are protected from being canceled once they get sick, group policy members should know that companies such as Anthem Blue Cross of California often deny coverage for medical treatments prescribed by physicians.
My husband's claims for thousands of dollars of charges for life-saving chemotherapy were denied by one of California's largest insurance carriers. We were very lucky to have an oncologist who went unpaid for many months while we fought for coverage. Fortunately, in our case, our carrier's denial was overturned.
This election must be a game-changer where healthcare coverage and administration are concerned. Each American should vote as if their life depends on it because, sadly, it may.
I am one of those fortunate Americans who still has a group health insurance plan from my employer. Several weeks ago, I went to my local emergency room with severe chest pains. Thankfully, all tests indicated that I had not had a heart attack, and I was released after several hours and told to get a treadmill EKG "immediately." But my insurance company says such a procedure must be pre-authorized or else it will not pay for it, and that process will take anywhere from four to six weeks.
I am so glad we don't live in a country with "socialized medicine," where there are long waits for needed treatments and healthcare decisions are made by bureaucrats instead of doctors, aren't you?
As if that weren't enough, I just received a bill from the emergency room for more than $2,000 in fees that my insurance company now says aren't covered by my policy. This isn't health insurance, it's health unsure-ance!
Recently, my healthy 22-year-old daughter graduated college and became ineligible for our group insurance plan. She applied for an individual Blue Cross policy. When she filled out her application, she reported the one medication she has used regularly for years: an antibiotic face wash suggested by a dermatology colleague to prevent her from getting those adolescent pimples that puberty often causes. My daughter has perfect skin and has never paid a visit to a dermatologist.
Imagine my outrage when Blue Cross offered her a policy at 50% more than the usual premium because of her history of "pimple prevention." The letter said that her premium could be reevaluated if she could demonstrate that she was free of "pimple prevention" for an entire year. As a physician and a reluctant member of the Blue Cross provider network, I wrote a letter explaining that prevention is not a disease and that there is no ICD9 code for "pimple prevention."
Blue Cross then relented and offered her the policy at only 25% more than the usual premium. I guess risking a face full of zits is the price for obtaining insurance these days.
Paula Bernstein MD
The writer is associate clinical chief of gynecology at Cedars Sinai Medical Center.
This is the system that John McCain, who wants people to "choose their own health plans," is espousing. The free market will always develop plans that are only open to the perfectly healthy. I don't know why nobody challenges McCain on the obvious consequences of letting the unregulated free market control access to healthcare.