Insurance Haters

KelRN215, BSN, RN · Dec 6, 2015

I'll bite. I am an insurance hater. I hate them as a nurse and I hate them as a consumer.

I hate that I had to turn down a job earlier this year because the health insurance offered was not sufficient to meet my needs. I hate that the company that I did accept a job with changed their insurance options and eliminated my platinum plan, forcing me to purchase a plan with a $2000 deductible and an 80/20 coinsurance until a ridiculous $5000 OOP max is met. I hate that next year, I can expect a bill for somewhere in the neighborhood of $3000 for my annual MRI. I hate that, at the age of 31, I may need to look into leaving a job that I really like because of health insurance. I hate that, on the eve of my annual MRI which already has me stressed out, I got a voicemail from some 3rd party MRI provider, undoubtedly trying to convince me to schedule my MRI at their facility instead, to save my insurance company money. I hate that, because I was unfortunate enough to be diagnosed with a brain tumor at 17, I get to spend the rest of my life fighting with insurance companies for the care I need.

I have a friend who works in underwriting for a large insurer. It is his job to decide how much to increase premiums for employers, based on how much their employees use their plan. I may have told him that it's people like him who caused my platinum plan to be eliminated when it happened last month.

As a nurse, I hate that it's a fight for all of my patients every single time. I hate when I have to tell the parents of a child with Lyme disease that they need to be prepared to pay out of pocket for ceftriaxone because their insurer may deny and, yet, delaying treatment until we can get auth is unwise. I hate that I had to tell the parents of an infant who had a kidney transplant that his enteral therapy may cost them up to $900 in the month of January because his secondary Medicare won't cover his new deductible and coinsurance, since their guidelines are designed for adults. (He has it based on the renal failure/dialysis program they have.) I hate that, for so many of my patients, a large portion of the cost of their care is deferred to the tax payers (secondary Medicaid) because the private insurance that their parents pay for won't cover their care.

I am a huge proponent of a single payer system.

d'cm · Dec 18, 2015

I am also in favor of single payer but it still will be an insurance company be it CMS or UHC. The suggestion that insurance companies are the cause of the cost of healthcare is ridiculous. Healthcare is expensive because the providers of it charge a lot and there is no single payer that is big enough to set reimbursement except Medicare. The problem with Medicare is that the oversight of what is paid for is pathetically lax. Our whole system has evolved to exploit this lack of accountability. In order to increase revenue providers provide more. Just more, not better not effective and way way to often not medically necessary and potentially harmful. The example about the antibiotic for Lyme's is such a perfect example. Did the nurse educate the patient that there is very little evidence that ceftriaxone is no more effective than a placebo? Of course not. There is way to much money to made. How many of you have seen patients sent off to subacute "rehab" that have no rehab potential, or had no decline in function due to hospitalization or didn't even want to go in the first place, and come home in worse shape than they were to begin with.

This is why I work for an insurance company and not a hospital. Sometimes saying "no" is right thing to do.