Health Insurance: I Don’t Get It

If you know anything about my personal life, you know that I come from a family of psychologically mixed up people. My mother has been in and out of therapists’ offices since she was a teenager because of depression, psychosis, mania, anxiety, borderline personality disorder, etc. My father saw a therapist as a kid due to anger and is now dealing with post-traumatic stress disorder and intermittent explosive disorder, which he likes to joke about because it is abbreviated as IED. I am also nutty, and this is something that definitely impacts my daily life. We’re all on disability. My father collects for his psychiatric problems alone. My mother and I collect for a combination of psychiatric and physical problems. Because my disability began before I was 23 years old, I am covered under my mother’s Medicare. Because I’ve never held a “real” job, I am receive SSI and have Medicaid. This allows me to not have to get a supplementary health insurance. Before my father was approved for disability, my mom qualified for Medicaid because of our family’s monthly income. After he got approved for disability, they had to look for some kind of way to cover their health care costs. (Medicare does not pay for much and sometimes you can end up having to foot 50% of the cost for mental health care, which is part of why we go to a “public” facility.)

My mother and father got Humana insurance because it sounded like a good deal. Of course, insurance companies often have people who could sell a blind man 3D glasses. My father had worked at an insurance company once and some family members of mine have fairly important jobs at an insurance company, so my family knows a little bit about the business. Humana seemed like something they could afford and like something that would help their co-pays stay down. At first, it worked okay. It was never really stellar. From about the first doctor’s appointment after they got it, they got the runaround. People who were on the company’s list as approved providers would no longer be approved once Humana got the bill. My parents would be told that the list wasn’t completely accurate. This list could range from the ones they might send from their company to their beneficiaries or the lists available on their websites. They also told my parents that they couldn’t guarantee that anyone who thought they were approved actually was approved. This was fishy, but my parents had signed a contract and were basically stuck.

My parents thought about leaving Humana after the contract was up, but, as all pro-capitalist companies do, Humana promised a better type of insurance. It was one more geared to people with health problems, which one might think they would have offered to disability recipients off the bat. After my parents signed up, they learned that this plan was no better than the previous one. In fact, it could be worse than the other one in many ways.

Fast forward to last week. My father gets a superbill from Humana stating that he owes his therapist $100 because they didn’t approve of that therapist. My dad, the mental health center, and someone from Humana had worked together to find out who he could see. They found someone who could help him and that was covered, but once my dad got the bill, he found out that that person wasn’t covered. At first, he called Humana. They told him that that facility wasn’t covered because it couldn’t treat Medicare patients. My dad literally told them that that was bullshit. The facility in question sees people who are on Medicare, Medicaid, fixed-incomes, and some people who have private insurance. It sees everyone. Well, they blamed it on LifeSynch and told my dad that he would have to call “them”.

Now, if you notice in that image, LifeSynch is, according to its description, a Humana company. This means that Humana is blaming another part of Humana for this problem. Of course, it is Humana’s fault, so the blame should lie there. The problem is that by making this “other” company, they are increasing the amount of runaround that takes place. This delays treatment and can be detrimental to a person’s health, especially in a mental health case.

My father was eventually told that there was no list of approved providers, but (before LifeSynch told him that he shouldn’t get so angry) they would eventually say that they could send him a list. In the conversation they also said that they would have to approve every doctor or therapist he might need to see, but they told him that he didn’t need to have things pre-approved. He was getting more angry, and they eventually blamed the mental health care facility that he goes to.

When my dad called that facility, he understood that it wasn’t actually their fault. Instead this was the fault of the insurance company, which was trying to avoid paying claims. (According to several people who work in billing at different facilities, this is not uncommon with this particular company. They always find a way to NOT pay for services.) At his mental health provider, he found out that since the year began, that provider has changed employees who work specifically with Humana and LifeSynch at least 3 times. Three of the provider’s employees had been driven crazy by this one insurance company, no pun intended. This is a facility that will deal with anyone. They handle most insurances and most mental health problems. They treat all ages, as well. To find 1 company that stands out so incredibly is just appalling.

What is more appalling is that this is the kind of system we feel proud of in America. A health care system that makes it difficult, if not impossible, to get the health care you need. Now, some people may have valid reasons for not wanting socialized medicine, but I cannot imagine how a person can advocate for a system that allows for this level of unprofessional behavior from an insurance company.

I’ve watched programs where they talk to doctors at hospitals, like the 2000 series Hopkins 24/7. On these programs, you see people who are not allowed to have diagnostic tests done that could determine whether or not they “might” have cancer or a heart condition. We have a system where non-health care providers get to determine what type of service a person might receive from a doctor or hospital. This is a system that ends up causing more health care problems.

That might not seem like a big deal if you don’t care about this topic or (possibly) if you’re a sociopath and don’t care about humanity in general. It is a big deal, though. The sicker a person is, the less productive they are. The sooner a person gets appropriate medical care, the lower the risk that the illness will become a major hindrance on the person’s life and on their insurance. A person who might end up on disability for a potentially treatable condition might be able to stay employed. If that is the case, then the person will end up helping the economy. Having a healthy populace is beneficial to any country. So, why is it that we don’t advocate strongly for health care?

We allow companies to dictate what level care someone might have. It isn’t fair to the sick to say that they’re just not that important to us and that all that matters is that we keep big companies happy. We should protect people, instead of promoting a system that will only cause more damage to our society through the years. It seems like it would be easier on medical providers if there was 1 form of insurance and 1 way that a person’s services would be covered. Of course, closing out big businesses like Aetna, Humana, and Blue Cross/Blue Shield from the health care industry would not be popular among some Americans. It seems like we should be more concerned about what would be best for the country as a whole and not for the people who are making money off of giving such bad health care that a person will die a premature death.

About Janet Morris

I'm from Huntsville, Alabama. I've got as many college credits as a doctorate candidate, and the GPA of some of them, too. I have a boss by the name of Amy Pond. She's a dachshund. My parents both grew up in Alabama.