Wednesday, July 08, 2009

Unhappy with HealthAmerica

I am very unhappy with HealthAmerica, our college's health insurance provider. Our son had an ingrown toenail and the toe was infected. He was in great pain and was treated in January. Then we were billed the full amount. HealthAmerica said this was not covered. They have gone out of their way to wiggle out of paying anything. We appealed, they sent it to their Complaint Committee, and the committee sent us a final letter denying coverage for the procedure ("You have exhausted your complaint rights"), saying that "routine foot care" is not covered. The letter says that by exception "Medically Necessary surgery for ingrown toenails" would be covered. They didn't judge the relief of our son's pain or infection to be medically necessary. If you ever want to get a parent mad, that's it!

Other than helping my friend Dr. Ogan Gurel with his 700 mile Walk for Healthcare, I've been too passive in the ongoing debate about health care reform. The arrogance of companies like HealthAmerica angers me. I must and I will write my congressman and senators and urge them to vote for solutions that regulate such corporations more strictly and give Americans a public health care option. I have no confidence that HealthAmerica would actually cover us if something more serious were to occur.

1 comment:

ogangurel said...

Thanks for posting this, Geoff! And, of course, for your wonderful support of the Walk.

Hope your son has done better. An ingrown toenail is not a trivial condition and can progress, if not addressed, to more serious consequences. I am not surprised, however, at what you have experienced.

Here's a story from Chapter 4 (New Life) of Waves ...

Tomas recalled a time when they did have health insurance, but that had turned out to be a form of piracy.

They sat around the kitchen table. Olga had gone to sleep and the dishes were put away. A single sheet of paper lay before Nina; the two were arguing over this.
“It makes no sense,” said Nina, breathing noisily.
“That’s the way it works,” explained Tomas, reaching for the letter.
Nina snatched it away. “What do you mean ‘that’s the way it works’!?”
“Benefits denied. They’re not paying.”
“But the doctor ordered those tests, it was part of Olga’s check-up—before school.”
“I understand. And, yes, the policy covers—I read it—well-child care. But they figure they can get away with it.”
“Get away?” Nina gritted her teeth. “Get away with it?”
“Yes,” said Tomas calmly. “Let me explain. They figure people won’t complain. If they denied $3,000, people would kick and scream. If they denied three dollars, it wouldn’t be worth it to them.”
Nina shook the printed form in her hand. “Well—we will complain.”
“Yes, we will. But I’m telling you, it won’t be easy. Either the doctor is committing fraud—which I don’t think is the case here—or Blue Cross is committing the fraud. There’s no other explanation—”
Nina slammed the paper down. “And so we need to fix that.”
“Yes, my love. Welcome to America.”
Tomas knew he had been nickel and dimed. Nickel and dimed to the tune—‘It’s A Jungle Out There’—of $300 .

All that was in the past: the present now meant evening strolls here in the sweet-smelling gardens behind the School of Philosophy. And while they did not always agree, at least Tomas and Nina did not now boil over the hell caused by others.