7 Things I Hate About Insurance
In the last two months I have been dealing with far too much of insurance.
Exhibit A: About a month ago I found myself in the emergency room multiple nights in a row due to (what was then) unexplained, severe abdominal pain. I was going in because the amount of pain I was having scared me and I was determined to get answers as to what was causing it. While I worried if I had cancer (or something else big and awful), the ER doctors continuously gave me pain meds and sent me home, refusing to run diagnostic testing past the “are you currently dying?” stage.
On my third visit to the ER, I told the doctor on call that I couldn’t keep doing this… going home and waiting for the pain meds to wear off just to have extreme pain again and end up back in the ER. At this point, the doctor had told me that my only option for further testing was to wait weeks to get into both a gynecological and GI specialist. I pushed harder, advocating for myself to get any testing I could when the ER doctor finally told me we could do a pelvic ultrasound, the only test we hadn’t run yet that insurance would cover for an ER visit. Luckily, the pelvic ultrasound did give us some clarity. It showed signs that my endometriosis, that had been dormant for the past seven years I had been pregnant and breastfeeding, looked like it was returning and was likely the cause of my pain. With a semblance of an answer, the doctor agreed to give me at-home pain management to keep me out of the ER until I was able to get into the gynecologist and get a better care plan (which just happened this week!).
Exhibit B: As part of grant funding received from the Kansas City Health Department for my doula business, I have been required to sign up to take state insurance for my birth doula services. The process had been frustrating and time-consuming beyond measure. After spending days putting together the necessary documents and faxing them in (yes, these systems are still stuck in the early 2000s), It took me five months to hear back from the medicaid provider enrollment team. By then, they had determined that ALL of my paperwork had to be resubmitted because the originals were dated too long ago (even though the slow processing was on their end). After resubmitting all the documentation, they nitpicked through every line of a few forms, making me resubmit over and over for subtle changes they deemed necessary. I have spent days of office hours submitting documentation for a program that will only pay me half of my going doula rate if I do take a Medicaid eligible client.
Given my current frustration, I am making this blog post simply to rant. None of these reasons I hate insurance are ground-breaking, never-heard-of-before complaints. They are just things I want to get off my chest…
7 THINGS I HATE ABOUT INSURANCE
They underpay providers while overpaying their shareholders and CEOs
My going rate for basic doula care (no childbirth education classes) is $1500 and I am fully booked from now (March) until October, and yet Medicaid thinks I should only receive $700/client while spending hours submitting claims and waiting weeks/months for reimbursement. Most health care CEOs are making multiple millions in salary alone, not including their generous stock options.
They try as hard as they can to cover as little as possible
Instead of caring about their clients getting the best preventative and/or comprehensive care, they find every reason in the book to DENY DENY DENY, padding their pockets.
They get in the way of quality care
Instead of a doctor getting to treat a patient as swiftly as they need to be treated, they are held back with having to perform the necessary paperwork, gain preapprovals, and send in the necessary referrals to specialists; costing hours, days, and weeks in treatment time before patients can be seen and get the help they need in non-emergency situations.
Additionally, doctors can’t always treat patients with the protocols they think best serve their individual patient, but with what treatment insurance will deem acceptable to cover.
They overpromise and underdeliver
One of my biggest qualms with insurance as they start to “cover” doula services is that their promises fall very short. They tell their clients that they can get “free doula services!” but then when people go explore them, they find no doulas in their area take their insurance. This is because insurances are underpaying doulas and making it very difficult for them to sign up, giving doulas virtually no incentive to work with the insurance companies, as most established doulas have our services in demand enough to book out at our cash rate.
The person that suffers most in these scenarios? The pregnant people in our communities who are excited to get the chance to work with a birth doula, just to have their hopes dashed as they try researching their options.
They continue to jack up premiums while covering less and less care
With the threat of a large-scale health event always a possibility (cancer, car wreck, etc.) insurance companies know they have a service people want to have “just in case”. Americans are stuck in a state where insurance is not provided as a fully state-run system, but we also are penalized for having no insurance, or only catastrophic insurance coverage… creating a state where insurance companies have the upperhand to continue abusing the system for their own profit.
They determine what providers you are allowed to go to and when
Gone are the days where you can ask your neighbor the great family physician they go to and take their recommendation. Now everything is run by your health insurance company’s app; determining which doctors are in network and which ones you are allowed to go see. In an emergency where an ambulance takes you to a hospital not in affiliation with your insurance, you could see a catastrophically large bill compared to if you recieved care at the hospital down the street — none of those being things you should be worried about figuring out in a health emergency.
I have had many doula clients that have had to switch doctors between pregnancies (or even during pregnancy!) from OBGYNs or Midwives that they loved because them or their husband switched jobs, or their employers switched insurance carriers, leaving them with incongruent and subpar care.
Make profit through bureacracy — paying people to make people jump through hoop after hoop to get coverage or treat their patients
As I have dealt with getting signed up with insurance as a non-health care provider, I have realized even more how much bureaucracy is built into the system. There is a reason while many doctors’ offices may have several employees solely working to help them with insurance claims (a luxury a small doula organization doesn’t have).
At every turn, insurance companies have set up more roadblocks to getting covered, wasting your time and the time of the people at the insurance company who are helping you. The system could easily be ushered into streamlined, modern forms; but they likely keep it archaic to keep people from submitting claims that actually lead to them having to pay for the services they say they provide.
