Private Health Care Fraud

The headlines are relentless. “Anger at Town Hall Meetings.” “Public Option Dying.” “Death Panels Will Decide Health Care Options for the Old and Infirmed.” “Obama’s Health Care Plan Will Insure Free Health Care for Illegal Aliens.” On, and on and on: diverse circular arguments that appear to have no credible answers from Joe Schmoo on the street to John or Sally Congressperson who are supposed to be in the know. So, this is not about supporting the current health care plan floating around the airwaves, this is merely a reflection of how private health care insurers deal with patients.

Here is a real life situation that occurs all too often to individuals who are insured by private health insurance companies. The call was made by a patient to his/her insurance provider first thing this morning. Heather K broke a bone in her foot early Saturday evening. She managed to drive herself to the hospital’s emergency room a short ten minutes from her home.

On the plus side of modern day medical care: Heather K was whisked into an examining room and immediately sent to X-ray. The suspected broken bone was identified and Ms. K’s foot was placed in a temporary splint and sent home. The hospital where said emergency room is located did not have an orthopedic specialist on staff during the weekend. Ms. K was instructed that she would have to seek a referral from her primary care physician on Monday morning before she would be able to see an “in net work” orthopedic specialist to have her broken bone set and repaired.

Now, let’s review. Ms. K has golden private health insurance coverage but because there wasn’t an orthopedic specialist on call on an early Saturday evening or even on a Sunday morning, said patient with said golden private health insurance has to deal with a broken bone until Monday with instructions to take 600 mg. ibuprofen to staunch any discomfort during her vigil.

Question One: Since when do certain medical specialtists not work on weekends to provide medical care? Apparently for at least the last twenty years, especially at this specific world-renowned medical facility located in Pasadena, CA. My son broke his wrist playing soccer over twenty years ago and the same situation occurred at the very same hospital. No orthopedic specialist on staff during the weekends. And yes, I too had premium, golden medical insurance. When my son’s wrist was finally set, the pain he experienced to do so was so intense, even after having a mega sedative administered, that he had to be restrained until the procedure was completed. The concept of: “Do no harm,” seems to fly in the face of reality

Back to Ms. K’s adventure with her current golden private medical insurance. Ms. K rose bright and early this Monday morning to call her premium medical insurance company. She was told that she would not receive any care under her HMO unless she had a referral from her primary care physician, despite the fact that her computerized medical records disclosed that she had broken a bone.

Ms. K then proceeded to call the referral service who declined her request to see a specialist. The referral service informed Ms. K that she could utilize the POS (Point of Service

Option) outlined in her medical insurance policy where a patient will pay a deductible of $150.00 to $400.00 from an “out-of-network physician.” Think about it; a patient with a broken bone is told to utilize an option in a medical policy that requires them to pay for an emergency. Please remind me exactly why there are so many angry, insured protestors against the whiff of a change in medical care if the government gets involved? Exactly why are these people fighting to preserve this kind of treatment from private insurers?

To make a kind of long story shorter, let’s say that after hours of begging, pleading and arguing with various clerks and supervisors, Ms. K finally received the referral, in other words she received the right to seek medical care some seventy-two hours after she broke a bone. Am I the only one who thinks that this so-called kind medical treatment for anyone, whether they have private insurance or not, is obscene should never happen? I don’t know whether or not the stated Obama Health Insurance Plan will cure the country’s medical ills, but I do know that there is something decidedly wrong with a system that is supposed to heal and provide medical treatment to patients in emergencies and that monolith of bureaucracy that is private health insurance clearly slows down the process of health care simply to feed its insatiable, bottom line profit maw just to impede and/or stop quality patient care.

The point is: private insurance companies and their policies as currently administrated for their patients is no panacea. If there is going to be an effective health care plan to address the needs of a nation, then doctors will once again be responsible for healing rather than those unseen mindless, and often non-medically trained personnel whose only job is to ensure profits for an industry that is supposed to be motivated by high ideals such as: do what is necessary and right to provide better than average health care to its patients.