Opinion

Commentary: Tales from my battle with a health insurance company

I'm on hold — again.

Over the past few days I have spent an inordinate amount of time trying to convince Aetna, my insurance carrier, to pay for doctor-prescribed physical therapy. This has meant phoning the member-service number to coax along an appeal, an almost daily ritual as unpleasant but necessary as prepping for a colonoscopy.

Oh, wait, here's Gail, today's customer service rep. For the umpteenth time, I recite my spiel. I hear her keyboard clicking.

"Your appeal," she says, too sweetly, "is in the system."

"I know that," I reply, just as sweetly. Two days earlier, I had spoken to Nicole, and before that Christine, who provided the same information. "But has it been routed over to the appeals board?"

"It usually takes three days for that, ma'am."

"It's been five, if you count the weekend," I point out, sweetness seeping from my voice. "And I asked to expedite it."

I tell her how I have a window of opportunity in which to recover the range of motion in my right arm, how time is of the essence, how blah blah blah. She informs me that Aetna, like other insurance companies, has up to 30 days to make a decision. I know that already, but it doesn't get me the treatment I need when I need it.

I joke that wrestling with the insurance company is my new part-time job, but it's no laughing matter. I wonder how others in the same predicament fare. Do they have the time and wherewithal to fight? Can they maneuver through the layers of red tape?

I suspect many patients give up, which is exactly what insurance companies want. But is it good medical practice for someone who hasn't examined you to determine what you need?

Normally healthy and fit, I had a sanguine view of insurers that has turned to pure cynicism. Health, shmealth; it's about the bottom line. And if whatever ails you isn't enough to pump up the old blood pressure, dealing with the health-insurance bureaucracy surely will.

As health care reform dominates the headlines, public policy becomes personal. So allow me to be selfish here. Sure, it's important for all Americans to be insured and have access to good health care. I want this for my children, my grandchildren. But I also want to know how the new rules will affect people like me, the already-insured.

At the orthopedist's, we discuss the battle with my insurance carrier. He tells me my complaint is a familiar refrain.

"I hear people say they don't want the government to decide what kind of medical care they get," he says. "Well, I have news for them. Insurance companies do that already."

The subject is a surefire conversation starter. At the gym, a woman tells me how her hairdresser fought for cancer treatment for her husband. A friend recounts how her mother waged war to continue receiving the same medication she had been taking for years. Somebody knows somebody who, at 56, was dropped without warning from a private policy. And on and on.

The details of health care reform are still in flux, but of one thing I'm certain: Whether it's government or insurance-company bureaucrats making treatment decisions, we patients must learn to be our own best advocates.

Health, yes, is the greatest wealth, but you need pit-bull perseverance to guard it.

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