How I was cheated by my health insurance company, and why similar deceit may be the coup de grâce for the health insurance industry
I am a dream-come-true for a health insurance company: paying exorbitant premiums month after month, year after year, with rarely any claims, and no claims that amounted to much—I've spent considerably more for veterinary care for three chickens than on medical expenses for myself in the past 18 years. Since Blue Cross Blue Shield of Michigan (BCBSM) had made oodles of money off me, I didn't expect that they would treat me like stupid dirt, blowing me off with what amounted to hot air the first time I asked them to pay for something.
Yet they did. I was so stunned by what I heard that I asked to speak with a supervisor, who did an even better job of digging in her heels. I sought to resolve this disagreement by referencing my contract, which I did not have access to, but she obviously did.
Ms. Supervisor's demeanor manifested her contempt for me as a person and as a customer with a right to obtain benefits I paid for. She clearly enjoyed giving me a hard time, and was so stubbornly pugnacious that she wouldn't let me see my contract. She claimed that she couldn't provide me with a link to it online, nor could she send it as an e-mail attachment. I suggesting faxing it to me, but she said they didn't have fax machines.
Can you believe it? A multi-billion-dollar corporation doesn't have a frigging fax machine in the 21st century? I live in the middle of nowhere on a shoestring budget and I'd need to stop and think about how many fax machines I have. BCBSM employees obviously have computers, and every computer I've owned could send information, including my first one, a Tandy 100 with a 300-baud modem that I used by fitting a rubber doohickey on my telephone handset. That Stone Age computer predated MS-DOS and its flashing C: prompt. Yet it could transfer files!
The supervisor said she would (snail) mail the contract to me and that I'd have it in two weeks. I could walk to their office in Detroit and back in less time, so I wondered why they took so long.
Why? To give a customer yet another stumbling block.
Judging by her thinly-veiled contempt, I seriously doubted that she would mail the contract. Two weeks came and went without any contract. Over three years and multiple phone calls later, I have yet to see that contract, confirming my suspicion that not only she didn't want me to see it, but neither did any other BCBSM employee. In speaking with their workers, I learned that BCBSM does indeed have fax machines. That's hardly a surprise; what is surprising is that a supervisor would be so determined to screw me that she concocted a lie that is transparently absurd.
In denying claims and otherwise trying to brush off customers, BCBSM makes decisions that are screwy and even illegal. For example, they denied coverage to a policyholder injured while snowmobiling, refusing to pay for the part of his rescue that transported him from the accident scene to the road even though ambulance services are a defined benefit in his contract. Evidently BCBSM thinks people should pay for that unless they can walk out on their own. Michigan's Commissioner of Financial and Insurance Regulation disagreed and ordered them to pay for what any insurance company would pay unless they had rocks in their heads or ice in their hearts. I find it impossible to believe that BCBSM hires employees that stupid, so if they are bright enough to realize they should have paid that essential portion of the ambulance services without giving the policyholder and his wife a hard time, WHY DIDN'T THEY?
Why? Because they do have cold hearts; because they evidently think that trying to cheat customers is part of their job: to be such hard-asses that customers give up in frustration. BCBSM knows that policyholders with claims are often stressed by their health problems, sapping their ability to fight another battle: against their health insurance company. Those companies take advantage of that vulnerability, wearing their customers down until they give up.
Many Americans are so sick of this battle for coverage that they'd jump for joy if the government put all health insurance companies and their workers out of business. While I initially opposed ObamaCare and other legislation that paves the way for a government takeover of health insurance, I am so incensed by what BCBSM did to me that I thought of (and will later publish) a way to make government-run health insurance so appealing that even Tea Party folks would crave it—I should know, because I was one (see the notes at the end of this article to read why I'm not). The best way to pay health insurance companies back for their callous and unethical treatment is to put all of their employees on unemployment. (The ones who aren't callous also deserve to lose their jobs because none of their inside-the-box brains have conceived of ways to substantially curb healthcare costs without penalizing patients, doctors, and hospitals.)
I am not the only one who thinks BCBSM doesn't play by the rules. One of its competitors, Aetna, sued them, alleging they violated federal antitrust laws. So does the U.S. Department of Justice, which sued the Michigan Blues. The evidence against them appears damning. I predict that Blue Cross will get a black eye—in court.
A salient and defining characteristic of criminals and criminal organizations is that they do not do the right thing until they are compelled by a court of law. I paid BCBSM with money that was perfectly good, but what I received from them wasn't good; it was abominable and acting in bad faith: a legal term for fraudulent deception involving the intentional or malicious refusal to perform a contractual obligation, or misleading another, violating basic standards of honesty.
Blue Cross Blue Shield of Michigan could not claim they honestly acted in good faith with me unless they want people hearing their pathetic excuses about their inexcusable behavior to erupt in laughter.
No online contract? No ability to send it as an e-mail or e-mail attachment? No fax machine? No frigging stamp to mail a letter? Gee whiz, what planet are they are on? What century are they living in?
Health insurance companies throw stumbling blocks in front of their customers, hoping to trip them up or frustrate them into giving up so the big, bad insurance company has more money to lavish on its overpaid executives—even those who work at nonprofit corporations.
One of the biggest myths of all time is that leaders of nonprofit companies are not concerned about profits. Oh yes they are!
Many people think of nonprofit corporations as friendly, benevolent organizations. Wrong! Here's the real difference:
Instead of distributing profits to shareholders (as most corporations do), nonprofit corporations keep it and divide it amongst the top brass, who can be paid well over $1 million per year.
Leaders of nonprofit corporations often run them as money-making machines to support their desires to live like kings. If that's at your expense, tough luck. If they need to cheat to do it, they will. If they need to have their employees lie through their teeth, they will.
Can't send an e-mail? No fax machine? Can't figure out how to put a stamp on a letter and mail an envelope?
Lie, lie, lie, but that's Blue Cross Blue Shield of Michigan for you, and they're not the only health insurance company to use tactics that only thugs would approve of.
Picture this: I was at home, building some electronic gizmo I invented, when my phone rang. The caller was the husband of a patient I treated. He was practically in tears and clearly exasperated as he related his many struggles to have their insurance company pay for her ER visit.
Now, I've seen many folks in the ER for less than legitimate reasons (e.g., a lady with a loose vagina who wanted stat surgery [as if!], and a hot-to-trot man who wanted me to find a nurse to be his bed buddy [as if!]), but this wasn't one of those BS cases. This man and his wife were your typical rock-solid, sensible Main Street people. She had a legitimate reason for being in the ER, and her insurance company should have paid that bill without giving her husband an ulcer and gray hair, but when greedy insurance companies get their rapacious hands on money, they'll be darned if they'll give it to you if they can think of a way to not do it.
I couldn't force the insurance company to pay her bill, so I helped them out by canceling 100% of their ER bill sent by the ER group I worked for (many doctors who work in hospitals work for independent professional corporations that separately bill patients for services). I did that by giving them and others professional courtesy even if they weren't doctors—the usual recipients of professional courtesy. That meant we earned less than zero for those patients, since we had plenty of expenses, but I was happy to help them. Surprisingly, my bosses never said a word to me about all the free care I gave away to hospital co-workers, EMTs and paramedics, police officers and firemen, veterans, single mothers struggling to survive, and many others who struck my fancy as decent folks deserving a break.
In speaking with me on the phone, the BCBSM representative and supervisor quickly projected a defiant, oppositional attitude that went well beyond what is expected from a greedy insurance company. I could think of only one plausible explanation for their exceptional truculence: racism. I sent the following e-mail to BCBSM on July 19, 2011:
I will discuss Blue Cross and Blue Shield of Michigan in an upcoming book on racism. Specifically, I will recount my experience with your organization as a patient when BCBS of MI was my health insurance company. The reference will not be favorable. I can think of no other plausible explanation for why I was treated as I was, and why I was given such preposterous statements from one of your supervisors. I discussed my heinous treatment with a BCBS investigator afterward who confirmed that what that supervisor told me was false. Indeed, it was not just factually inaccurate, it was utterly absurd, even laughable. Hence, a public discussion of this may prove to be a public relations nightmare for BCBS of MI that may open a can of worms, so to speak, in subjecting your organization to scrutiny from various governmental and civil rights organizations, in addition to a possible class action lawsuit from others who may have been similarly victimized by BCBS of MI employees.
I assume BCBS of MI has policies that prohibit racial discrimination and that your organization would bend over backwards to right any wrong in this regard to insured members, such as myself. However, judging by the way BCBS of MI dragged out the investigation of my incident, I concluded that instead of dealing with it expeditiously and fairly, you hoped that I would forget about it. I will not, and I cannot.
The focus of my book is on a rapid way of reversing racism in almost everyone, except for sociopaths and others with defects of conscience. Thus, BCBS of MI will not be the centerpiece of my book, but it will be used to illustrate how racism has yet to be extinguished and how corporations give lip service to prohibiting racial discrimination but do little or nothing to help erase racist sentiments in their employees. The latter would of course be much more effective than putting a Band-Aid on this problem.
I am writing to offer BCBS of MI the chance to respond before my book is published. I intend to pillory your organization with a vengeance, so you may wish to accept my offer. I recommend that you also remind your employees that your customers are people who wish to be treated with decency and respect. When customers receive substandard treatment, you should attempt to rapidly remedy that wrong and have the offending employee personally apologize to the aggrieved party.
I sent the following e-mail October 5, 2011 at 12:25 PM:
I received a call from BCBS of MI a few minutes ago, presumably in response to the message (below) I sent 7-19-2011. However, the BCBS caller did not leave a message or direct phone contact number. If you wish to discuss this matter on the phone, please arrange a mutually convenient time in advance.
Other than that flaky call in which they didn't leave a message, I didn't hear from them regarding my offer giving them a chance to refute my allegations against them. Realistically, what could they say to justify what they did? For them to even attempt justifying their actions is as offensive as when criminals concoct lame excuses for their misdeeds. If BCBSM has the slightest shred of decency, their CEO would personally apologize to me. Isn't the buck supposed to stop with the CEO? Or does the BCBSM buck stop with folks who brush off customers by lying to them?
No e-mail.
No link.
No fax.
No stamp.
No honesty, hence not dealing in good faith with a customer.
Not all corporations are as honestly seeking profits as what Republican candidates want you to believe; even seemingly Main Street businesses can be either tied to the Mafia or act as if they do. (Relevant personal tidbit: I once was a staunch Republican, but then I woke up; I still sometimes agree with them, but not as often as I once did.)
Picture this, another true story from my life: I delayed starting college for a year to work and save money for it. One of my jobs was serving as a personal assistant to a disabled man, Warren Ritchie, who was a real go-getter. My job was to help him out of his wheelchair and into his specially-equipped car that we'd travel in to his office and various appointments. He thought enough of me that he let me sit in on meetings with various big shots in their walnut-paneled offices, but I had little interest in his business, so I'd often just sit and read in his car or office.
I killed time by reading one day while sitting in the receptionist's desk at his office when, lo and behold, two men entered. One didn't waste much time before he was strangling me so hard I could barely speak. Not surprisingly, he'd skipped the usual pleasantries such as hello and how are you doing?
Not very well with two strong hands wrapped around my neck!
The source of his wrath? My boss apparently hadn't paid his bill for this Woodward Avenue office supply company that employed this bill collector. The goon assumed I was the boss, and hence the debtor, even though I was 18 years old and still had peach fuzz on my face, which was now turning purple as the strong-armer crushed my throat.
Surprisingly, part of me enjoyed this assault, flattered that me—Mr. Nobody—could be mistaken for a Mr. Somebody. Wow, he thinks this is my office, and my bill. I wished it were, but I also wished for the chance to get his vice grip off my neck, so I struggled to speak, saying, “I … am … not … Warren … Ritchie. He's … in … the … back … room.”
This office supply company in the upscale Birmingham/Bloomfield Hills (Michigan) area didn't seem to be one that would have bill collectors using Mafia-like tactics, but they did, and they're not alone. I was physically assaulted in my home by the electrician who wired it.
People who read my blog know that I detest anyone who thinks that might makes right. Some corporations, such as BCBSM, use their might to run roughshod over others. I think so, and so does Aetna and the U.S. Department of Justice. Blue Cross Blue Shield of Michigan doesn't care if they give a customer a figurative black eye or bloody nose; money means more to them than people. Ironically, in their quest for money, they neglect ways to economize on healthcare without harming patients, doctors, or hospitals. That is not surprising, because thugs are rarely brilliant, preferring the instinctively obvious ways to get money over methods that require ingenuity.
Health insurance companies have screwed countless people besides me. Barack Obama felt that his mother was unfairly denied coverage, which may have kindled his desire to reform American healthcare in ways that would lessen the ability of insurance companies to dictatorially and unfairly say what they will and will not cover. (Update: Glenn Beck, citing author Scott Wright, said that Obama's story wasn't accurate.)
If ObamaCare is fully implemented, health insurance companies will be weakened and, many believe, they will go out of business, with the government filling the vacuum left by their departure. I say goodbye and good riddance, because with the missing link I will supply (the one alluded to above), government-run health insurance could be much better than the current system in which Goliath private companies use their power to cheat customers—figurative Davids. An analysis of David-versus-Goliath conflicts revealed that “When underdogs choose not to play by Goliath’s rules, they win.”
Notes:
- Not all nonprofit corporations are led by greedy people more interested in money than their mission, but many of them are, and I've yet to hear of a nonprofit health insurance company that didn't act as if profiting from their customers was more important than giving them what they paid for without giving them a hard time.
- BCBSM wants to have a life and death impact on people's lives, and they want to have unfettered freedom to do so callously, carelessly, capriciously, and without repercussions. I hope Aetna and the U.S. Department of Justice win their lawsuits against BCBSM.
- The contract that the BCBSM supervisor claimed she would mail to me almost certainly was not sent. Contrary to what some people think, the United States Postal Service loses so few letters that when one is not received, it is almost proof beyond a reasonable doubt that it was not sent.
- I once was an ardent Tea Party supporter, but now I even more passionately believe that they have no realistic chance of saving our nation and restoring our prosperity. Big shots in the “small government can save us” crowd were so impressed by what I wrote that they asked me to write for them. Thus, if you don't believe the liberals, believe me: the Tea Party is doing little more than wasting our time, diverting our attention from workable solutions that don't require pixie dust. Our government won't significantly shrink unless it collapses; token Tea Party cuts will do as little to enhance our long-term survival as skipping a couple of cupcakes will do to save an obese diabetic. The only solution that can save us and give us reason to celebrate is one that does more for everyone—conservative, liberal, Right, Left, and in between—regardless of whether they pay taxes or receive government assistance. Impossible? No. I presented my plan explaining it in another article. I offered $100,000 to the first person to explain why it couldn't work, and no one attempted to collect that reward—nor will they, unless they are stupid—because my plan obviously is workable and realistic, allowing us to prosper even with a leech-like government that deems itself indispensable. That big government is on our backs, and they're not getting off until they crush us. We could carry that load with my plan, or we can continue to listen to the Disney-like “ain't never gonna happen” Tea Party fairy tales that are the political equivalent of snake oil.
- Excerpt from ERs Have Become De Facto Psych Wards: “rationing by hassle factor”—that's the strategy used by health insurance companies: hassle and frustrate customers until they just give up.
- Single-Payer Health Care Is Coming To America-Are We Ready? Excerpt: “Right now, the for-profit [health insurance] model sucks about $400 billion a year out of our health care dollars to pay for administrative costs—costs that largely disappear in a public system where administrative costs run dramatically lower.”
Comment: Some of that $400 billion went to BCBSM so it could lie to me, which thwarted my attempt to obtain the insurance coverage I'd paid so much for.
Comment: That $400 billion wasted translates to $1286 wasted for every person in the United States every year. Health insurance companies burn that money without giving you any healthcare, but they do give you plenty of hassles. - MediBid: a great idea and an alternative (or supplement) to insurance.
- MediCrats: Medical Bureaucrats that Rule your Health Care
“The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.”
— F. Scott Fitzgerald
Reference: Imagining dialogue can boost critical thinking: Excerpt: “Examining an issue as a debate or dialogue between two sides helps people apply deeper, more sophisticated reasoning …”
Comment #223 by defmanthebogeyman
July 16 2012 05:16:09 PM
Wow, no matter what story I read, it's just so insane, what they did to you, Kevin. No respect, just craziness. You'd think they're possessed by demons, or something.
I would not stand for such crap. I would dump the company and move to another one. Customers DO NOT deserve to be treated so shabbily. Dump Blue Cross and move to a better company that treats its own customers with RESPECT!
Mafias are thugs and stupid and they don't deserve to be in business in any way, shape, or form. They should be PUT DOWN for keeps.
REPLY FROM KEVIN PEZZI: BCBS of Michigan was worse than the Mafia man who strangled me (as I mentioned above), because the Mafioso at least gave me a sincere apology after he realized I wasn't the guy he wanted. When BCBS of Michigan is less cultured than a Mafia bill collector … well, need I say more?