Okay, example number 2. While I was out of town I went to the doctor for a UTI. The doctor said they didn't take my insurance so I paid up front, asking for a receipt so I could be reimbursed by the insurance for this covered service. When I submitted a receipt to the insurance they said they needed further documentation from the doctor. When the doctor gave them this documentation it was a bill for more money than I paid in cash at the time of service. The explanation from the doctor is that I was given a discount for paying in cash. Yet, the insurance company is now saying this is the new bill and issued a check to the doctor for the services I already paid for! When I asked the insurance company why they didn't just reimburse me, they said the doctor sent them a bill and they paid it. But the doctor didn't send them a bill, they asked for documentation of services that I already paid for! The doctor's office now claims that it was a bill, simply to get more money for the services. It is important to keep in mind during this whole process, from May 2012 until January 2013, I called the insurance company repeatedly (think: more than 50 times) without sensible explanation, sometimes being told that they simply do not reimburse people, sometimes being told that they made a mistake, or I did or the doctor did. Speaking with all different people with all different levels of competency and familiarity with the case. Each time, I had to re-explain the situation and never once was I transferred to a supervisor when asked (each time I was transferred I got a voicemail with no return call). Needless to say, I never got reimbursed for the services.
Final example. Patrick went to the student health center for what he thought was a broken wrist. This health center deals with our insurance constantly. After he went there, he got three separate bills in the mail that all charged him directly for the services. These bills were from: the health center from the doctor who saw him, the local hospital which administers the x-ray machine, and the radiologist in spokane that read the xray. Why wasn't the insurance billed for these services? And why was he getting three separate bills for one visit in the same building? Well, the insurance company has decided that for each claim the patient needs to fill out a separate claim form which basically asks you if there's any way this sickness/injury can be covered by any other place (worker's comp, previous insurance) every time you ask for them to pay for services. So, they are simply providing another hurdle to paying for services by asking you to fill out this form on your own before the doctor can submit a claim. So, in order for the insurance to be billed for this one doctor's visit for Patrick, he had to download and print three of these claim forms, fill each of them out, find out the billing address for each institution and mail each of them to three separate institutions who can then finally submit a claim to the insurance. He is still in the process of completing this from a doctor's visit from October 2012. The most infuriating part is that this was a big investigation process to figure out why the insurance wasn't being billed and how to fix it. It took multiple emails, phone calls and bills to piece together this mystery. In the meantime, he is getting bills sent to his student account through the university where late fees are being applied, and bills that are threatening to send him to collections.
How did this system come to be? How can we be so alienated from one another? Just based on these few experiences, this is the least rational system for caring for the health of one another in society that I can imagine. Sociologist George Ritzer calls this the "irrationality of rationality" where several independent rational decisions add up to make an irrational system. But I don't think that's what's going on here. Whomever decided at the insurance company that patients needed to fill out a claim form every time was not making a rational decision; he/she was making a selfish one. The company does not want to pay claims. The insurance company's goal is to make money, not to provide health insurance for the medical needs of its customers. So, someone decided to include this hurdle to paying out claims. I think what's going on here is the irrationality of greed. Not only are people alienated from one another or from the consequences of their decisions by the division of labor, they are also making decisions based on the bottom line of this society: profit. So, that's how it comes to be that someone dies on the emergency room floor while waiting for care. This is how it comes to be that even when you have insurance and you follow all the rules, you're sent to collection for bills you were never meant to pay, keeping the powerless down in a cycle of poverty while the powerful reap the rewards. I've got to get out of this place.