Ahh yes, life in BushWorld, such a wondrous thing. As I sit here watching gas prices wearing out horses to get to $3 a gallon, I smile as today's headlines in the Arizona Republic shout about the profits Big Oil is making and the fact that the small garage guy is being shoved out of business because the oil companies charge more and more from them for credit card sales. Do unto others, right? But hey, I'm not here to chat about black gold. I'd like to discuss those other burgeoning Bushie benefactors - the Health Insurance companies. I'll set the stage for you.
I have a good friend, Pam, who's 59 years old and has been the secretary for the Nursing Department of a local Community College for the past 10 years or so. She's got her degree, so she makes decent money - approximately $33,000 per year. Her 58 year old hubbster is on disability social security and brings home about $1,200 a month.
Two years ago, Pam's heart went into afibrillation, which is to say her heart beat was speeded up and out of sync. She went to the hospital and went through the shocking experience of getting her heart set right again. Mission accomplished. After a couple of days, she was fine again. It happened again in January and again she was put right quickly and back to work after only a couple of days off.
Other than a life-long bout with asthma, Pam's only other problem has been trouble with her arthritic knees. All the cartilage has been worn away so she gets cortisone shots about every three months so she's able to go to work. Pam's heart doctor, her knee doctor, and her family physician have told her she should undergo gastric bypass to lose weight quickly so her knees could be operated on (if necessary). All three doc's wrote letters to Pam's insurance company to explain the need for this surgery. Pam's been a heavy gal most of her life and she's tried a gazillion diets, none of which has worked for very long, so she was looking forward to getting the bypass done and losing most of her excess weight.
But her insurance company came back and told her they wouldn't pay for the surgery unless she could prove to them that dieting doesn't work. Again, her doctors wrote confirming this, but to no avail. She was turned down again.
Each year in July, the college allows changes to be made to your health plan. It's also the time of year you get your annual raise. Each year, Pam used her raise to increase her Short and Long Term Disability insurance.
In May, Pam started having chronic lung problems, being unable to breathe, gasping for air after walking only a short distance. Her primary physician kept her home from work and sent her to a lung specialist. After the two week waiting period, Pam applied for short term disability. It took another week for them to process and finally, she received a check for two weeks. This was about the 11th of June. Then something odd happened. She received no more checks.
Pam called the insurance company and they told her that since the problem was pre-existing, she wouldn't be paid the higher amount (the increase that went into effect on 1 July) unless she could prove that she did not suffer from this problem in year 2004. Pam went about the arduous procedure of collecting info from her doctors and mailing it to the insurance company. She gave them everything the girl had asked for.
Two weeks went by and no word from the insurance company. Pam called and was told her claims person was out of the office. They then told her that the ruling was that she has asthma and since that's a pre-existing condition, she couldn't get an increased amount. And asthma is only covered on the plan for 1 week. So she shouldn't expect another check soon unless she could provide them with documentation proving that her sickness was not asmetha related.
Remember - the insurance company made no attempt to call my friend concerning their decision, but just let it ride, hoping it would all go away. But Pam and her husband have been living on his paltry social security check for 3 months now. They're preparing to purchase a nice, warm, cardboard box so they can take up residence in a public park after they are thrown out of their apartment complex.
As of this writing, the circumstance still isn't resolved. Even though 3 doctors have written and stated that Pam can't work - the insurance company keeps asking for more and more documentation. But she still has to make her payment each month. Nice, eh?
Why do people have to go through such things when they've paid religiously every month for a service that's now being withheld? Is this the America that's being passed on to my generation?
