health care reform is needed for the middle class just as much as the poor, and for health care providers as well. I'm not talking about the public option now, just reform and regulation of the industry.
I work at a non profit hospital. And every day private insurers have some new loophole, some new way to get out of paying claims. These insurances make completely arbitrary rules that they change on a weekly basis in order to get out of paying claims. so for instance, they'll get a claim, and say say: we'll only pay for procedure x if on the same day pt has procedure z. But procedure x and z are completely unrelated. There is no reason a patient WOULD have procedure x and z on the same day except if they needed both of them out of sheer coincidence. Sometimes the patient absorbs the cost, sometimes the hospital, sometmes both pay part. it depends upon the contract the insurance has with the hospital. i used to work in the denied claims division, and it was ridiculous. for instance, even if the insurance company was the one who screwed up, they STILL wouldn't pay. so, for instance, the hospital called United healthcare to obtain an authorization for a patient. We were told by United Healthcare that no authorization is needed for that procedure. We are given a reference # for our call. The claim then denies because there was no authorizaton in place. We show United healthcare the reference #'d case in which we tried to obtain authorization and was told one was not required. They state that doesn't matter. all that matters is that there is no authorization on file, and one was needed, so they won't pay. We got denied claims like that all the time, every day.
the biggest problem right now is that private insurances get to decide what's medically necessary. They get to decide what doctors you see, what procedures you are allowed to have, what drugs you can get (you know, exactly what the right is telling you what will hapen if government takes over). I work at a cancer hospital. So obviously, people are only getting medical necessary treatment. Yet every day we have numerous patients who are denied medically necessary care from major insurers. And a patient can't just switch coverage for 2 reasons. 1. most people's insurance is chosen by their employer and 2. Every private insurer I have ever encountered denies medically necessary treatment. *edit I don't mean all the time. all i mean is that it's a roll of the dice on whether your insurance will approve your treatment. and every private insurance i've worked with has denied service for people as 'not medically mecessary" when it is.
health care reform is needed to protect the middle class. we see patients who have paid thousands of dollars over the years in premiums to the top health insurances money can by, only to then get sick, and be denied the product (health coverage) they've been paying for all these years, because the insurance medical directors get to decide what's necessary, not the doctors. you don't need to be poor to not be able to afford hundreds of thousands in medical costs when your insurance denies you.
