Worse Than the Mob: The Insurance Industry Is Organized Crime [View all]

[WilliamPitt]

(Photo: England / Flickr)

Worse Than the Mob: The Insurance Industry Is Organized Crime
By William Rivers Pitt
Truthout | Op-Ed

Thursday 06 March 2014

We got accountants playin' God
and countin' out the pills
Yeah, I know, that sucks - that your HMO
Ain't doin' what you thought it would do
But everybody's gotta die sometime...

- Steve Earle

(snip)

There is exactly one insurance company in New Hampshire peddling plans through the ACA: Anthem BlueCross BlueShield. After completing the enrollment process through the exchange, the next step was to deal directly with Anthem, which quickly came to be about as fruitful as trying to batter down a brick wall with my daughter's teething ring. First it was two weeks of phone calls, involving serial hours listening to on-hold music that could easily have come straight out of a bad porn movie soundtrack, just to establish that Anthem actually recognized Multiple Sclerosis as a real disease. Then it was another week of porn-flick hold-music to get a straight answer on the location and availability of MS doctors that were "in the network," and thus covered.

Every phone call yielded a different set of answers, a different phone number to call, which invariably led nowhere. The calls that finally yielded answers and useful information felt like luck-of-the-draw; we either got someone on the line who actually felt like working that day, or were simply fortunate that the person we spoke to actually picked the correct answer off their sheet of go-away pat responses. In the end, all of this took so long that we wound up shelling out nearly a thousand dollars to get COBRA coverage from my wife's employer, just to make sure we had something over our heads. Finally, after almost a month of nonsense, we managed to get everything squared away, I cut Anthem a check, and we received insurance cards in the mail.

All was quiet for a while, until the beginning of last week, when my wife's MS medication began to run low. Previously, and with no hassles, the process to acquire a refill for her prescription was to call the company that makes her medicine about a week before it ran out, place an order for a refill, and it would be delivered two days later. When we called the drug company at the beginning of last week, however, we hit a great big pothole: they could not do the refill until our new insurance company approved it.

My wife contacted Anthem a month ago to clear the way for this approval process. They required a statement from her neurologist in order for the prescription to be approved. That statement was acquired, and sent to Anthem, a month ago. According to every conversation we had with Anthem this week, however, the statement from her neurologist did not exist, and the process had to begin again from scratch.

And so it was phone calls to Anthem, and more phone calls, and hold music - between the two of us, my wife and I have logged enough hours on hold to fly to Neptune and back - and one answer with one phone call once we finally got someone on the line, another answer with another phone call once we finally got someone on the line, and all the while my wife's stock of MS medicine dwindled, and dwindled, and dwindled.

Last Wednesday, fearing the worst, my wife began rationing her medicine: one dose a day instead of two. We made this very clear to the people at Anthem - I HAVE MS AND AM ALMOST OUT OF MEDICINE - but still, it was "Call this number" that went nowhere, "Call that number" that went nowhere, one answer, and then another, no two ever the same, the awful infinity of hold music, and then oops, we accidentally inverted the numbers on your prescription, we have to start over again, we will call you back, and then silence, and silence, and silence.

For those not in the know, Multiple Sclerosis is an auto-immune disease that causes the body's own immune system to attack the brain. Think of the neurons in your brain as if they were stereo cables: copper wiring encased in a rubber sheath. With MS, the immune system chews through that rubber sheath and attacks the wiring, destroying it. The damage done is irreversible, and in the worst case can cause paralysis, blindness, weakness, loss of motor function in arms and legs, an inability to swallow, and permanent disabling pain. It is a filthy, wretched disease that does not even have the common decency to kill you after it is done torturing you; it leaves that to the other diseases that come galloping through the door after your body has been destroyed. The only thing keeping the beast at bay is my wife's medication. When she has it, she is fine and strong, able to work and hold her child, able to live a normal life. When she does not have it, she is hedging Hell.

This was the cocked pistol at my wife's head as we tried and failed all week to get Anthem to approve her prescription refill.

(snip)

Whatever other flaws may exist within the ACA, the one aspect of it that is a perfect good is the law's mandate against people with pre-existing conditions being denied coverage, or getting wildly over-charged because of their condition. Before the law's passage, this pool of customers - more than half the country, by the numbers - represented the insurance industry's main cash cow, their profit engine...and when the ACA became law, they lost that, and are now seeking to make up the profit gap wherever and however they can.

The ban on insurance companies denying coverage for people with pre-existing conditions, or over-charging for that coverage, is comparable to telling the Mafia they can no longer take kick-backs from the businesses under their "protection." In the movie Goodfellas, the main character, Henry Hill, succinctly lays out the Mob's business philosophy regarding those who are struggling to make ends meet:

"Business bad? Fuck you, pay me. Oh, you had a fire? Fuck you, pay me. Place got hit by lightning, huh? Fuck you, pay me."

In other words, they're going to get paid one way or the other. If the insurance industry can't screw you by charging triple rates for your pre-existing condition, they will get their pound of flesh some other way, like denying or delaying approval of an expensive prescription for a serious medical condition that will ruin your body and your life. But they are going to get that pound of flesh, and nothing is going to stop them.

Fuck you, pay me.

The Mafia has broken a lot of legs over the years, and put a lot of bodies in the ground, and extorted a lot of money from fearful people who have no choice but to obey, but the Mafia is left in deep shade by the insurance industry in America. The Republicans have spent oceans of time over the last few years yodeling about fictional "death panels" being a part of the ACA, but those "death panels" are all too real, and have existed for years in the guise of insurance companies that will drain your body of blood before refusing to approve coverage for a transfusion.

The rest: http://www.truth-out.org/opinion/item/22279-william-rivers-pitt-worse-than-the-mob-the-insurance-industry-is-organized-crime

...and we're still waiting for her medicine to arrive.