Memo to Anthem: There is nothing wrong with my breasts

22 Jun

I am a single, self-employed healthy and active child-free 47-year-old woman who is very frustrated with our country’s healthcare system.

For the past three years, I have had a COBRA plan that expired in early May; at the highest the monthly rate was close to $600, a great deal of money for someone who takes no medicines, has no health issues and is not employed full-time by a corporation. Before this plan ran out, I attempted to obtain through the same company, Anthem, a high-deductible plan with a low monthly payment of around $120.

When I applied for this – using as a liaison a Blue Cross Blue Shield agent in Louisville, KY, who I located via an 800 number – I had to be responsible for my medical chart getting faxed to the agent, who then saw that it got to an underwriter in California. After a couple of weeks, this underwriter denied me the desired coverage and instead offered me a plan for over $500 a month because, they said erroneously, I had “lumps in both breasts and needed a mammogram.” If they had read my medical chart carefully, they would have seen that I had just had a mammogram that was perfectly normal and have had no issues related to my breasts. My breasts are perfectly fine.

Needless to say, I did not want this new $500 plan, so I rejected it and decided to appeal the company’s denial with the help of my would-be agent. My doctor had to write a letter to the underwriter stating that the reason for denial of coverage was completely inapplicable to me and should have no bearing on my ability to get the plan I wanted. She told me it was ridiculous for them to say my breasts had any issues when the first thing in my chart is the most recent mammogram report: completely normal. For the process to be expedited, the letter needed to get from my doctor to my agent and then to the underwriter; I was told that if the doctor sent it directly to the underwriter, the wait for approval could be months. All this while, I had to manage this communication happening in a timely fashion, overseeing the chain of correspondence between my doctor, the underwriter and my agent at Blue Cross. I got the letter faxed… and waited. For a couple of weeks there was no word.

Then suddenly last week, without getting another chance to accept or reject a plan, without any word from my liaison “agent,” Anthem sends me a bill for two months, this one (June) and the previous one (May) during which I had no coverage because of their delay in stating that I had health issues that were not in my medical records. The rate is higher than I had wanted, but not so high that I would reject the plan – or so they assumed. They also sent me a new plastic i.d. card and a ton of information about a healthcare savings account I am supposed to make deposits to and withdrawals from. I have not authorized or accepted any of this. Additionally, I told my agent at the beginning of the process that I did not want any paper products and needed everything sent to me electronically. Now I have a disgusting pile of inscrutable print booklets cluttering my desk – enough reading material for an entire summer.

What perturbs me most is that I am being billed for something I did not accept or reject yet, and also am being asked to pay for a month in which I was not covered at all. Obviously nothing bad happened to me during that month, so I don’t need coverage for that month, but this is all being done under the sacrosanct principle that there should be no “lapse in coverage” or else I will be rejected out-of-hand for having a “pre-existing condition.” So what this means is that millions of people every day are paying for months of “coverage” that the insurance company really didn’t have to cover them for. Is this fear-based system of “care” condonable?

Yesterday a friend related to me a story about a middle-aged man in North Carolina who robbed a bank of $1 so he would be arrested and taken to a jail where he would at least receive decent health care for his medical issues. Has America come to this?

I work for myself and cannot afford a $500-600-a-month health insurance plan. I am tempted to have no plan at all because I am so disappointed that our country pays thousands of people to skim medical charts, pick out a few choice words related to some random body part and string them together with the express intent to intimidate even healthy consumers into paying more than they should for insurance. If this doesn’t work, because the person sees through this scam and manages the communications required for an appeal, the company does not even professionally offer the person a plan, but bills them directly for it after a “reasonable” delay, requiring them to pay for months in which there has been no provision of any service whatsoever – all this when the client was trying their best to get timely coverage.

I know many middle aged people out there like me who are relatively healthy, self employed, and go without medical coverage of any kind. It feels like this is the future for me too because I do not want to play this sick healthcare game, which I feel should be declared illegal. I would love to hear from anyone who has similar experiences and thoughts to share; who can pull away the dark curtain of confusion and somehow shine a good light on this process; who will tell me with impunity that I just need to bite the bullet and be happy I have a plan; or maybe even offer an alternative solution. I am especially interested in hearing from those who have moved away from conventional medicine toward homeopathy and naturopathy.

The artwork for this entry is provided by Kathleen Farago May, who lives in Canada but spent part of her life dealing with the US healthcare system. Her choice was to spend much of that time without healthcare coverage. She educated herself in alternative and natural healing and maintained her health holistically. Instead of lining the pockets of the insurance companies to ensure that ailments could be treated as they appeared, she found that being proactive in prevention was of greater value for her dollar and for her life. Learn more about Kathleen and her work here or click here for a price guide and her email address. 

3 Responses to “Memo to Anthem: There is nothing wrong with my breasts”

  1. Marianna McDonald June 22, 2011 at 8:33 pm #

    The insurance companies think they’re all powerful because the Republicans have tagged “ObamaCare” to be the culprit for tons of wasted American taxpayer dollars when in fact the previous Republican administration wasted tons of taxpayer dollars on a trumped up drug bill which has continued to lined the pockets of the drug companies and insurance companies.

  2. Amy DeFelice-Ryan June 23, 2011 at 5:36 am #

    As a self employed cancer survivor who has been insured, uninsured, on cobra, denied coverage, denied benefits for prexisting conditions-because of the lapse in coverage you speak of-and as a still self employed person currently paying $400 a month for cobra…..I understand. I am mad. I am sad. I am ashamed of the system we have created, on many levels. I DO remind myself I’m supremely lucky to have health insurance at all when I start feeling indignant but my good fortune should not replace the indignation this appalling system calls for.

  3. StrangerInAStrangeLand June 23, 2011 at 9:24 am #

    Why didn’t you apply to another company? Also, you didn’t need to pay any back premiums for the two months you weren’t covered because under HIPAA, you can have up to a 63 day lapse in health insurance coverage, and as long as you were continuously covered for the past 5 prior years, you would not be subject to any pre-existing conditions (as long as you weren’t ill or injured when you applied for the new coverage, of course). You agent sounds like he was working for BCBS instead of you. He should have looked at multiple carriers if he saw problems with getting suitable coverage from BCBS.

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