Saturday, April 2, 2011

Medical Insurance Companies Suck the Big Bone

I’ve been one of those fortunates who had medical coverage for most of my working life. However, several years ago my job disappeared. No worries. Now I could get COBRA (Consolidated Omnibus Budget Reconciliation Act) passed by Congress in 1986 that gave certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates. The American Recovery and Reinvestment Act (ARRA) provided COBRA at a reduced cost, which for me meant that I would roughly pay one third, $390 per month as opposed to $1200. Still, this was a lot of money for someone who had been covered for many years through my employer. But I could meet that cost, at least for awhile.

Q. What happens when COBRA expires and the iceberg starts to melt? 

A. What iceberg are you talking about? 

Q. Health coverage. You know.

I figured I could not be without health coverage. As a teenager I had been in and out of hospitals with an undiagnosed case of colitis at a time when not much was known about the disease. Later, I had a serious case of pneumonia that nearly had me packing my bags to the afterlife.  Both events left me with a lasting impression about the importance of medical coverage. It also singed upon my person the need to play an active role in maintaining personal health.

I do not need any prescriptions. Blood pressure is good. So is cholesterol. I exercise, eat right, and have friends, which is to say I’m in great health. Once COBRA ran out I was confident I could apply to my health care provider, Kaiser Hospital, for individual coverage. But guess what? I was denied.

Q. Why?

A. Chronic renal failure otherwise known as lousy kidneys

“But I have never been diagnosed with chronic renal failure,” I cried to myself. “Were those medical miscreants looking at someone else’s medical records?” Then the light dawned. Last year during my round of check-ups some miniscule amounts of blood were detected in my urine. My doctor had sent me in for several tests to ensure that my kidneys were in good working order. They were. However, the initial diagnosis had placed me in a medical netherworld that no insurance company would now touch.

Upset not only because number one -- I was being denied medical coverage -- and number two – assigned a diagnosis that didn’t exist, I appealed to my doctor who sent me in for a number of very detailed tests to establish that my kidneys were in good shape. She wrote to me, “It is not unusual to get the kind of treatment you are experiencing. The bean counters in the health plan are charged with the task of letting only the healthiest patients who won't overutilize resources get through.”

There you have it. I appealed the decision and received two letters dated on the exact same day. One said that “Please be assured that we take this matter seriously and it is currently under investigation.”

The second later informed me, “Our record review indicates that you have been diagnosed with chronic renal failure, stage III. This condition does not meet our KPIF enrollment criteria."

I have filed a grievance with copies of my new medical tests and await Kaiser’s next decision. In the meantime, I urge you all to file letters if you are denied coverage. Stuff email boxes. Raise your own legal hoops. Talk with your representatives.  This has to stop.  Our country is being taken over by people with priorities that have nothing to do with life, liberty, and the pursuit of happiness.

Lenore Weiss