When I left my job at the beginning of 2015, I dutifully went out and purchased health insurance from the healthcare.gov website. It was the rock-bottom cheapest plan that’s sold, in the metal scheme I think it’s below bronze, probably aluminum. It featured a $6500 deductible, which I figured would hurt if I used it but it wouldn’t ruin me. Besides, I am pretty healthy and don’t need a lot of work. Famous last words.
So, about three weeks after I bought the insurance, I needed work. At first some work, then more work, then a good lot of work. I’m fine now, thank you, but I ran up quite a bill. Thank goodness I had insurance, sort of. My insurer proved very efficient at collecting premiums, dunning me without fail once a month. They haven’t been so good at paying bills, or anything else. After four months I dropped them because I got married and got on my wife’s insurance. I notified my insurer of this in the recommended fashion. I kept getting premium notices. I called to remind them that I dropped them and I still kept getting premium notices, which I then ignored until I finally got a rueful letter telling me that they were dropping me because I wasn’t paying them.
I also kept getting explanations of benefits periodically, which listed in great detail what bills they were refusing to pay, which was pretty much all of them. I’ve been through this before, I just let it all go, figuring that at some point the hospital and the insurer would hash out their differences. Then, two weeks ago I got a bill from the hospital for $24,548.75, because they had not heard from my insurer. I filed a complaint with the insurance commissioner, then went to the hospital and called my insurer with a member of the billing department standing at my elbow. The explanation I got was that there was an incorrect code on one line for one charge, which held everything up. The nice lady at the billing office said she would fix it. I was irritated but hopeful.
Two days ago, I got two pieces of mail from my insurer. One was an EOB denying payment of all the charges because the claims had been filed too late. The second was a generic corporate birthday card to their loyal customer, four months after I had stopped paying them and two weeks after my birthday.
I don’t even think this insurance company is especially inept or dishonest. I think they are pretty representative of their species, based on the similar stories of health insurance I have heard from my patients. I began this year thinking that health insurers should get out of primary care medicine, and vice versa. Now, given that they seem to have no talent except collecting money and no benefit to anyone except their employees and shareholders, I am coming to wonder if commercial health insurers should exist at all.