16 February 2011

Private health insurance ensures you pay

Private health insurance ensures you pay ; Barely had Ted Morton announced he would run for the Tory leadership, than speculation began about the stance he might take on health care. The Friends of Medicare worry he might resurrect his position from the last leadership race, which was that, as per Ralph Klein's late, unlamented Third Way; Albertans should be able to buy private insurance to pay for private services.

And while another aspiring Alberta premier, Wildrose Alliance Leader Danielle Smith says her party will abide by the Canada Health Act, when I talked to her in 2009, I asked her if she still holds her earlier beliefs about health care. She said, "Oh, sure." In 2006, she advocated for Albertans to have "the choice to purchase private insurance and pay for more procedures out of their own pockets."

After experiencing private health insurance firsthand recently, my question is: Why would anybody subject themselves to such a financial horror show?

My husband, Mark, is a health-care professional in Texas. In early December, he suddenly fell seriously ill and was hospitalized for five days. He has basic health insurance from his employer, but he pays an extra $60 out of his own pocket each month to bring his deductible down. The deductible this year is $900. That figure doesn't include co-pays. His insurance company tells him he will have to fork out a maximum of $5,000 in co-pays himself each year before they will step in and pick up the cost.

So here come some of the bills for his five-day hospital stay. The emergency room bill includes a $100 co-pay. The cost for two CT scans is $828; the insurance company says Mark must pay $246 of that himself. A doctor assigned by the hospital to see him on rounds sent in his bill for five daily twominute visits, which totalled $722.

"Doctors can bill whatever they want," Mark says, "but the insurance company decides how much the final charge will be."

The insurance company decided the doctor would only be allowed to bill $312 for those five visits, not $722, and it only covered $250 of that, leaving Mark to pay $62.

Not all the bills for that hospital stay have come in yet, but new ones have since been racked up, including a third CT scan.

Last month, Mark underwent major surgery to fix the problem that caused his illness. He was hospitalized for a week. Only one bill has come in so far. It's from the surgeon and it totals $7,225 for the 21/2-hour operation. The insurance company has informed Mark he will have to pay $1,125 of that out of his own pocket. Still to come, the amounts are unknown, are the anesthesiologist's bill, which his insurance says he must pay 25 per cent of, and, among others, a bill from the pathologist who looked at the diseased tissue that was removed (percentage Mark must pay of this still to be determined). Small miracle: his policy covered the lab bill for all the blood and other tests, because he is a health-care worker; the average patient would otherwise have to cover 25 per cent of his own lab tests. Then, there's the medication.

"A bill for medications in your IV and other drugs they give you in the hospital could easily run into the hundreds," Mark says.

Home again, and in debilitating post-operative pain, Mark received a letter from his insurance company.

"They wanted proof that I needed the surgery before they could approve it, even though it was already done," Mark says. Without the surgery, his illness could have been fatal. However, the insurance company insisted that he provide them with the doctor's notes, the results of various exams and other detailed information from his file within 40 days of the date their letter was written (seven days had already elapsed from the mailing date) or they wouldn't cover any of his hospital bills.

He phoned them and left a message saying that it was his job to lie on the table and have surgery, and it was his job to recover from surgery; it was not his job as a patient, who was in pain and unable even to leave the house, to obtain, photocopy and mail information from the doctor's files on behalf of the insurance company. They never returned his call.

"Dealing with this process is extremely stressful," Mark says.

As a health-care professional, he knows these things "happen everywhere in the American health-care system."

Yet, this kind of financial hit is what ideologues, lost in their free-market dreams, have in previous messages, proposed for Albertans under the guise of "choice." Choice should offer you something good. There's nothing good about any of this.

Nor was the nursing care that I observed better than Mark would have received in a Canadian hospital. In some instances, it was worse.

I suspect any politician who advocates inflicting this nightmare on Albertans has the best interests of insurance companies, not of Albertans, at heart.

Mark has a smarter message for Albertans: "For the physical and emotional well-being of your society, stick with the single-payer system."

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