Thursday, August 15, 2013

American Shakedown Part II: The Health Insurance Criminal Racket

I recently underwent surgery for a broken bone in my foot. I am insured through a PPO. I pay over $5000 a year for my individual insurance. Before the procedure, I asked repeatedly how much would the hospital cost, how much the surgeon's fee, the anesthesiologist, nobody would tell me. They all said: "But you have insurance, right? Don't worry about it".
I did everything by the book. I used an in-network doctor and in-network facility. I called the insurance company to ask about pre-certification. Yet a few days ago, I get an "explanation of benefits" letter telling me that I owe $20,120.13 for a three hour outpatient hospital stay, not including the surgeon ($3500) and anesthesiologist ($1350) fees, for which apparently the insurance company has deemed I am totally responsible. The reason: they needed more information on what caused the fracture, even though I filled out three different forms at the doctor, the hospital and the physical therapy explaining the issue. Basically, they are trying to see if it sticks and screw me over. Now I have to make calls and contest claims; a frightening and totally unnecessary outcome.
The insurance companies use deliberately confusing language. I had to read my insurance coverage book three times in order to understand what is and isn't covered. What is the difference between and copayment and a co-insurance? What does out-of-pocket mean?
Then you should take a look at the "explanation of benefits". The hospital charges are fifteen line items, "explained" by mysterious procedure codes like 587 and 452. So hell if I know what exactly they are charging me for. A kleenex? Sedatives? What?
This insurance criminal racket is simply armed robbery. Medical expenses are the only instance in human society in which consumers purchase services without knowing the amounts they cost, which are deliberately obscured by the providers. We are getting raped, and no one is doing anything about it. Obamacare was watered down to placate the insurance racket, not to help the citizens of this country.
Of all the absurd injustices in this virulently capitalistic country, the health insurance scam is the first thing that needs to be reformed and regulated, because it affects absolutely everybody. It is nothing but organized crime, and the abominable politicians who line their pockets at the expense of the American people and the bidding of the insurance industry should be skinned alive in the hot sun and hung out to dry. Americans should be up in arms. 


  1. katya9:25 AM

    dude, you're freaking me out. I have freelancers insurance too.....

  2. grandenchilada9:28 AM

    I hope it's just a ploy to see if someone is stupid enough to shell out the cash without argument, but it is WRONG!

  3. katya9:37 AM

    who cares how you got the fracture? what, they think you are faking it? you did it on purpose? and what about if you get something worse with longer treatment. It's appalling. Makes me want to move to Norway
    Even in Spain they just take care of you and charge like $25.
    Freaking joke