Sunday, July 15, 2007


Jul. 15, 2007 (McClatchy-Tribune Regional News delivered by Newstex) --
If I wasn't feeling a bit weak and dizzy after watching the film 'Sicko,' reading a recent stack of letters from readers of my column left me downright woozy.

Two weeks ago I asked readers to share their experiences with health insurance. Since then, e-mail messages, letters and phone calls continue to arrive. While I heard from one or two who were unabashedly supportive of their insurance companies, most were full of complaints.

The messages started with this one: 'It's 5:33 a.m. on Sunday morning, but I couldn't wait to finish my coffee or finish the paper, to get to my computer to answer your call for examples of arbitrary denials by insurance companies,' wrote Stephen Reichard, a Spokane health care consultant.

Reichard pays $700 a month for coverage for himself and two daughters, and yet every six months, he says, his insurance company begins to deny his claims. He estimates he pays over $10,000 annually for insurance coverage for three very healthy people. And when he asks his insurer why his claims are being denied, he reports they say, 'Oh, we do that will all of our customers every six months.'

Bill Rhodes, a retired music professor who taught 20 years at the University of Texas and now lives in Coeur d'Alene, wrote a letter describing his experience.

'A year ago, I endured a stay at the hospital to the tune of $14,000,' he wrote. 'My claim ... was summarily denied on the grounds of 'not covered.' Two weeks later, I asked the hospital's insurance liaison to try again. She did and, again, no dice: this time on the grounds that I would have been covered, but my benefits were exhausted.

'Two weeks later, I asked the hospital to try yet a third time. Voila! The insurance people coughed it up.'

One man wrote of his appreciation for Group Health, but he's convinced the rest of the country would be better off with a national health care system. 'I've seen 'Sicko,' ' he wrote, 'and discussed it with my sister who is in administration at a hospital in Portland. She tells me that all in all, the movie is fairly accurate in its portrayal of most of the health insurance companies in this country.

'She also points out that we are the only country in the developed world that doesn't have a national health plan and we have almost the shortest life span at birth in the developed world. On average, we would live more than two years longer just by moving 100 miles north to Canada.'

A Spokane colon and rectal surgeon, Dr. M. Shane McNevin, sent a long e-mail on 'the current health care morass,' which threatens to leave the community with a critical shortage of doctors.

Not a day goes by that he doesn't need to deal with this issue, writing documentation letters and making phone calls to help his patients convince their insurers to pay. 'Additionally,' he writes, 'our practice employs 11 people whose sole duty is to navigate the Byzantine legislation governing medical services reimbursement.'

McNevin, too, supports a single payer system, which he believes will require health care rationing, higher taxes and courageous politicians.

Anna Beard, the manager of strategic communications for Asuris Northwest Health, provided an insurance industry perspective. She blames the use of medical services, new technology and rising drug prices, along with increasing chronic disease rates and an aging population, for higher premium rates. She quotes a PricewaterhouseCoopers survey that showed that nationally 86 percent of each premium dollar goes directly to pay for medical service claims.

But many column readers weren't fans of their insurers' tactics.

'All I know is that, subject to contract exclusions, policy limits, yadayadayada, some portions of my medical care will be 'covered,' some won't,' wrote one woman. 'Sometimes I feel as though I'm rolling the dice, even with insurance.'

'To my knowledge, it's common practice to rebill, rebill and rebill with the hope that the insured will give up and pay,' wrote another reader. 'Somehow, somewhere, someone should be held accountable for this nationwide disgrace and manufactured fiasco.'

Underneath the anger, though, most of my readers sounded tenacious and resilient. What, I wonder, happens to those who aren't?

So does Reichard, that early morning e-mail writer. He described himself as a highly educated Type A personality who works as an advocate for groups often pushed around by society.

But he asks, 'What do you suppose happens to ordinary citizens when they receive Explanations of Benefits like those sent to me...? And what about the timid and the meek?'

Newstex ID: KRTB-0191-18142985


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