The Conscientious Consumer

Even when the mega-behemoth insurance emperor has no clothes, we are left with arrogance and assumptions of privilege. To see the truth about health insurance companies all we have to do is to look around. Check out this sad yet all too true column by Fort Wayne columnist Edith Kenna:

I have saved an article from a Fort Wayne newspaper of 2006 that reported Jason Govrevic, president of Wellpoint/Anthem’s New York market, had been spearheading an effort to encourage personal responsibility in its consumers (of health care). Mr. Govrevic is quoted as stating, “It’s all really designed to make you a more engaged consumer. We know that if you’re more involved in your health care — if you’re acting more as a conscientious consumer — it’ll be better for your health.”

I saved this article as I knew the time would come when I would have the opportunity to talk “responsibility” with my health insurance company. Well, that time arrived last month when I attempted to be a “conscientious consumer” by contacting Anthem after receiving what appeared to be a response to my physician’s request for prior authorization for a recommended procedure. The exact quote from the response that I received from Wellpoint/Anthem is as follows: “This is not an approval for claim payment. This approval is a confirmation of medical necessity only. We have not yet reviewed your health care plan. Depending on the limitations of the health care plan, we may pay all, part, or none of the claims.”

Wanting to be “engaged” in my health care decisions, wanting to be responsible (vs. irresponsible), and certainly not wanting to join the ranks of the 77,000 Hoosiers who in 2005 declared bankruptcy due to medical expenses, I decided to phone customer service of Wellpoint/Anthem to find out just when they were planning to “review my health care plan.” I requested an estimate of my out-of-pocket costs if I were to undergo this procedure. To be a “more engaged and conscientious consumer,” perhaps I would have to compare costs at various facilities, or even save money to have the procedure done. Don’t we “responsible consumers” usually get an estimate to have the car repaired, the house painted or the leaky toilet fixed? I just wanted to take this cost under consideration and make a financial plan in keeping with my budget. I am simply a middle-class worker with modest salary and savings trying to do the “responsible” thing.

Wellpoint/Anthem, a multimillion-dollar industry with many technological and financial resources available, wants me to be responsible, but they say they cannot, or will not, provide me with any such “estimate.” Wellpoint/Anthem states that I must first undergo the procedure, which they state is a medical necessity, before they will review my health care plan or let me know my out-of-pocket costs.

Somehow, this is not what Mr. Govrevic of Wellpoint/Anthem was implying in the copy of the Fort Wayne newspaper that I saved for just this occasion. I mean, after all, Anthem has a contract with my physician, the facilities at which the procedure could be provided and a contract with both me and my employer. Somehow, I don’t think I’m the only person who has ever had this particular procedure done in Fort Wayne. My out-of-pocket costs should not be a secret from me. Surely someone at Anthem has a calculator, and, at this particular point, it is only they with whom I have a contract. Being a “well-informed consumer,” I have not hired the facility nor the physician to complete this procedure because I don’t know what it costs.

I am insulted again by private health insurance talking about what consumers need to do but not providing simple customer service in good faith. Once again I am dealing with the arrogance of a health insurance company that, in my opinion, is acting in bad faith by insisting that only I act responsibly. It is ridiculous that I must first incur the debt to know the final cost that will be borne by me.

Private insurance companies have become too arrogant and too powerful. It is no longer clear what role private insurers serve in the delivery of health care, other than to skim money from the consumer while defining ever more narrowly who is deserving of what care – or any care whatsoever. We have become a society of insiders and outsiders.

We currently have a non-system of illness management. It is clearly time for all Americans to have access to a simple plan that it accessible, affordable, portable and of quality. It is time for a single-payer system in which we all are on the inside and not pushed toward or treated as an outsider.

The health care coverage we all need and deserve is currently outlined in a bill, HR 676, which has been reintroduced by Rep. John Conyers into the House Ways and Means Committee. This bill, if enacted into law, would extend Medicare to all at reasonable costs, simply, affordably and with responsibility shared between the individual, the government and the medical system. It is definitely time for all Americans to encourage a hearing on HR 676. Compromise plans being proposed by cautious reformers will all provide more muddle and run into the same political problems and strong pharmaceutical and insurance company lobbies.