Health Coverage Frustration

OK. I’ve done my best to stave off a rant on health care coverage, especially since I’m sick and tired of hearing people, ahem, politicians, health insurance companies and the like, put forth the same arguments for and against health care reform. They all take a rather narrow-minded view of health insurance reform, and are completely ignoring something basic: the health insurance application process.

If you want everyone to have coverage, then you must simplify the application process. Case in point: me.

Just to recap: I got laid off in April 2008, making me ineligible for extended benefits, or what I’ve referred to as inadvertently being ahead of the pack. Knowing my COBRA insurance would run out after 18 months, the maximum length of time for coverage, and would not be extended under new legislation since I was laid off well before the masses, I applied for individual coverage. I’m a fairly health individual, take 0 prescription drugs but like to have a plan in case of the unexpected, especially after getting hit by a CTA bus. I came away from that unscathed, but with a profound sense that accidents happen (the bus hit me, not the other way round) and I may not always be as fortunate.

I did some initial research, and I found that I still liked my current carrier and that an individual plan would save me roughly $300 a month over COBRA. I momentarily kicked myself for not switching earlier, but there had been the chance of gainful employment that brings with it health insurance coverage. Plus, it is the 3rd time I’ve had this particular health insurance carrier so my records are already with them. In triplicate, actually, which I find rather silly but didn’t know exactly how ridiculous this was until I applied for individual coverage.

Logic dictates that since I am already insured by said carrier, indeed have been insured by said carrier, switching from an employer to an individual plan should not be equivalent to walking through a mine field shackled and blind folded. They have my information, they have my records, they have what is needed. When I called to inquire about switching, I asked if they can just transfer my records from an employer account to the individual account I wanted to set up. The person laughed. Nope. Doesn’t work that way. I have to re-apply and re-submit my medical records. All of them.

Now keep in mind I am not changing carriers; I am using the same carrier. They have my records. The records have to be submitted for claims, and there have been a few claims since I have been insured by said carrier. Bottom line: they have the records.

Apparently, though, no division communicates with any other division. They cannot simply move my records from the “employer” division to the “individual” division, and then check for discrepancies and make records requests for incomplete information. No. I have to go through a completely separate, wonderfully detailed application process. The majority of the questions, by the way, would have been answered if they had been able to move my records. And they clearly have access to my claims history because they read it back to me over the phone, and inquired about each one. My answered verified what they had on their screen.

So this is where my frustration has started to…OK…has boiled over. If they can pull up my claim information, why can’t they then review my records? Why is it that I had to sign 4 records releases? 4! And here we are, more than a month later, and I am still waiting for the underwriter to approve or deny my application.

Yes. That’s right. Approve or Deny. Without employer coverage, there is the possibility of being denied coverage. If I’m denied coverage, I’d hate to see what happens to people who have submitted 0 claims and also take 0 prescriptions.

That’s not what annoys me, though. What annoys me is the silos. How on earth can there be any kind of meaningful health care reform if health care insurance companies cannot even share information within their own walls? And if they can’t even do that, how can they possibly field requests for information from out-of-state hospitals? Seriously. What happens if I am in a serious accident or have to be hospitalized in Arizona, Florida, Maine or *gulp* overseas? If it takes more than a month simply to request records and “process” an application, how long does it take to send my information to a hospital somewhere else?

I talked about this whole medical records transfer issue in a previous post on electronic medical record portability, but this lack of internal communication makes me think the problem runs much deeper than anyone, myself, Congress, anyone, originally conceived.

My point, though, is that if health care coverage is to be granted to everyone, then Congress must force the health care insurance industry to simplify its process. So if a person like me, who is KEEPING THE SAME INSURANCE CARRIER, applies for individual coverage, the process should happen much more quickly than if I were to change carriers.

Otherwise, shelve health care reform and focus on creating jobs as that will be the only way the rest of us will be able to obtain health care coverage.

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