This is why we need a public option.

August 19, 2009

Thank you to all who have shared your personal stories and you have my sympathies with what has happened to your families. I hadn’t intended on updating this blog but it seems that the current political climate has made these issues particularly timely.

I posted this story for my wife. This is her accounting of what happened to her mother just last year. She had gone so many rounds with AARP reps on the phone and in writing and got no answers but plenty of excuses and double talk. In the end there was simply no one to talk to. No one to simply listen to how someone suffered and died as the result of red tape and insurance company greed. We were just left with nothing. The only thing I could think to do was to try to share our story with others in the only way I could think of.

Clearly, we are not alone. Others of you have had the same or similar experiences. Why? Because insurance companies have been allowed to operate unchecked for far too long. Sure, they will cover some small, inexpensive medical needs, but when you really need the insurance they find or fabricate some reason why they can’t help you. What kind of insurance is that? The only thing I want from insurance is for them to be there when the big, terrible, and expensive things happen. Isn’t that what “insurance” means in the first place? But little by little these companies have turned farther and farther from the business of helping people and toward the business of bilking people… and we’ve let them do it by not standing up for one another. Now is the time to make these companies actually do what they are supposed to do by supporting health insurance reform.

I don’t know if the current proposals in Washington will create the “ideal” system, but at the very least it is the first real way to start to hold these insurance companies accountable to those they insure as opposed to their stock holders. Having a public health insurance option will create new competition, reduce costs, and require insurance companies to either help their customers or lose them. Think about our system of both public and private colleges and universities. There are good public options, and there are good private options. Having more groups in the education market gives people a wide range of choices and forces all of them to provide better service to their customers. The public option didn’t destroy the private schools, in fact it forced them to adapt and evolve into better programs. At the same time, the quality of education in public universities is also excellent.

Maybe this is simplistic and maybe you’re opposed to it for some sort of political ideological reason. That’s fine. The fact is that we can do better in the world of health insurance and we as a people deserve better.

There is one final thing I’d like to say about the politics involved here. I’m going to quote this because it’s my original saying and I think it’s a pretty good one. “The greatest trick that government has played on the people is creating a two party system. It keeps the people arguing amongst themselves about being Democrats or Republicans so we spend more time infighting instead of actually fighting for our government to actually represent us.” That’s a Nathan Moon original right there, and you can take that to the bank.

Insurance let’s you down when you really need it

May 18, 2008

My mother died in April and the health insurance nightmare that surrounded her final days has left us frustrated and saddened beyond belief. In our efforts to find out what her insurance situation was and to make sure the same problems wouldn’t happen to our father should he need health coverage we have gotten nothing but double talk, misdirection, non-responsiveness, and outright lies to such a degree as to raise the question of whether the “Medicare Supplemental Insurance” offered by AARP through United Healthcare-Secure Horizons is really just another scam to bilk seniors out of their hard-earned money.

We have tried to get straight answers from United Healthcare-Secure Horizons, AARP, individual agents, state regulators, and federal programs but have gotten no help whatsoever. We have nowhere left to turn so I’m sharing our story here to serve as a cautionary tale to others. If you or a loved one has “Medicare Supplemental Insurance” through AARP and United Healthcare-Secure Horizons (or whatever insurance you have) I urge you to read on and then make sure you have the coverage you really want for when you need it.

After they turned 65, my parents signed up for and paid for “Medicare Supplemental Insurance” through AARP which uses United Healthcare-Secure Horizons to provide the policies. They thought they were being responsible and giving themselves a little more assurance for the day they may need to call upon that coverage. This turned out to be a huge mistake. In fact, by having this “coverage” Mom was actually PREVENTED from getting services she would have gotten under Medicare alone.

Here’s what happened. My mother suffered a heart attack and when the doctors tried to treat he with blood thinners it led to a catastrophic stroke with no chance of recovering due to the amount of damage that was done. Our family eventually decided to leave our Christ-loving mom to God’s hands and had her removed from artificial life support. We then began the process of discharging her from the hospital to a nursing home/hospice care facility (where one of her daughters actually worked as a nurse) in her hometown.

We contacted both customer service and the United Healthcare-Secure Horizons on-site nursing representative at the hospital to inquire about our options for finding my mother a nursing home or hospice care. Because my father is elderly and has a mentally disabled child living at home with him, we explained the necessity of finding some service relatively near his home. A customer service representative informed us that there were no services available in their town. This was strange since my sister actually worked at the hospice in their town. Then, we were informed that my parents had an HMO plan – even though their insurance cards indicated they had a PPO plan – so we were told our options were limited even more. We were informed that the closest hospice facilities were at least 100 miles away. When we told them that there was a hospice facility in their town, we were told that United Healthcare-Secure Horizons would not cover any hospice care in that town, but we were not told why.

The representative at the hospital was also of no assistance. Administrators at the nursing home/Hospice facility paged her several times and we also paged her. She eventually called us and also stated that my mother would only be placed in facilities located at least 100 miles away.

After two days of trying to work with United Healthcare-Secure Horizons, my father decided to bring my mother home and have a local hospice worker come to check on her at his own expense. Thankfully my sisters who is also a nurse was able to provide additional assistance as needed.

I contacted the agents who sold the policy to my parents. Ronnie Horton stated that when my parents signed up for United Healthcare-Secure Horizons coverage, it became their primary insurance and not a supplemental policy as was represented. He also said that once my mother’s needs were of a hospice nature, Medicare/Medicaid would take over and provide coverage. He then stated that my parents did have a PPO plan and not an HMO plan as the previous representative told us. He indicated that the service area did include places much closer than we were initially told. Finally, he told us that someone from United Healthcare-Secure Horizons management would contact us to resolve the situation. This appeared to be a very helpful conversation, however, none of the promises actually came to fruition.

Two days later, I left a message for Mr. Horton stating that I had not yet been contacted by management at United Healthcare-Secure Horizons as promised. Another two days later Mr. Horton called and stated he would call United Healthcare-Secure Horizons again to have someone contact us. Later that day, Jorge Torres from the “escalation team” called and left a message. I returned his calls and left messages and it was another two days before we were actually able to speak. I again explained the situation and he stated he would research it.

Five days later I spoke with Mr. Torres who stated that my parents indeed did have PPO coverage and that he would send a document outlining their benefits. Benefits documents were received a week later for both of my parents, however they were for Hawaii, not Florida.  If nothing else, this shows just how carefully they were listening to our concerns.  Hawaii, Florida, they’re both sunny places right?

Later, my father received a letter to verify his county of residence. I called customer service and spoke to Christine to correct his county of residence because United Healthcare-Secure Horizons had inexplicably listed him in a county he has never lived in.  In fact he has lived at the same address in the same county for more than twenty years. Since I actually had someone on the phone I took the opportunity to ask her for primary care doctors in my father’s zip code. I was told that there were none. She then informed me that we had to initiate authorization for an out-of-network primary care doctor and was given a phone number to the authorization department. Upon calling the authorization department, I was informed the doctor had to initiate this. I then called the office of the doctor in Labelle that my parents had been using for more than a year and was told that they applied for the network authorization more than a year ago.

After this I called Mr. Torres again to explain all that had occurred (above) and that the benefits document that was sent was for Hawaii. He checked on the local doctor my father has been seeing for over a year and said that he was showing up in the system as a network doctor. I also told him about the problems with getting false and conflicting information from each representative we spoke to; he said he would “escalate” the matter to a manager.

Mr. Torres called me later and stated I had to contact the authorization department to find out the status of the network authorization my parents’ doctor submitted more than a year earlier as his computer system would for some reason no longer allow him to view the status. Seeing how successful I had been at getting information up to that point, I was not hopeful that I would be able to get the information when even he could not get it.

I again contacted the authorization department and was transferred five times before finding the status of the authorization. With each transfer, I was required to give the same information to verify my father’s identity, understandably, however the last person I spoke to, Monica, inexplicably said she did not show the correct birth date for my father though none of the previous four representatives had this problem.

I had believed the purpose of having insurance was that one could have peace of mind under times of medical emergencies. Upon dealing with United Healthcare-Secure Horizons, I no longer believe that. My family did not ask for much, no preferential treatment, no demands, we asked only for straight answers and reasonable options. All we received was stress, frustration, and a feeling of helplessness during the final days of my mother’s life. We were left with the sincere impression that my mother’s end-of-life needs were an inconvenience to United Healthcare-Secure Horizons, and that the best policy they could employ for their bottom line was to continually give false and inaccurate information and cause service delays until she died and would no longer be their problem.

No family should have to go through such needless distress. I do not wish another family to go through what we went through trying (and still trying) to get service for my mother and father.  Please be aware of what coverage you are or are not getting, and be prepared to take care of your family on your own when the time comes.


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