To be honest, I’m not doing great.
Trent Lapinski
225

Hi Trent,

I’m a follower of your writing. I enjoy reading your perspective even when I don’t always agree. It helps to keep me thinking outside my “bubble”.

I’m sorry that you are not in good health. I’m also sorry to read that your health insurance is inadequate. I’m self-employed (Practice Management Healthcare Consultant) and I purchase my and my husband’s health insurance via Covered California, the Exchange set up here under the ACA. I’ve worked in the health insurance industry for 23 years.

I’ve found that many times when patients cannot get the tests or treatment that they need, it may be due to the health insurance company’s unwillingness to authorize services that fall outside of what _they_ consider routine or basic.

For-profit Health insurance companies label policyholders using their insurance as “liabilities” not assets. It’s disguised under the industry term “utilization”. They tend to set-up unnecessarily complex and, in my opinion, deliberately confusing authorization processes in order to deny a policyholder services. Even when a health insurance company denies a test or treatment as “not a covered benefit”, many times there are ways to successfully appeal such decisions.

A successful appeal depends upon the laws of your state, your individual health insurance policy, the language used by the physician ordering the test or treatment when requesting authorization, and other variables.

You don’t know me but I’m happy to speak with you privately (I do not expect any payment) to see if there is something that may be done to assist you in getting the treatment that you need. I’m offering this because I hate the way health insurance companies fail to service their policy holders. After so many years in this industry and observing this type of behavior, I think it is a systematic and, possibly, intentional business model to boost their shareholders’ satisfaction by decreasing policyholders’ utilization.

In my opinion, this behavior highlights the fundamentally flawed ideology that drives most of our healthcare system: human health, illness, sickness, disease, and injury is a commodity to be bought and sold. I strongly disagree and I try to do my part in my work to hold health insurance companies accountable for the very real, very human lives behind the policies they issue.

Please feel free to reach out to me. I’m happy to answer general questions because I realize that you may feel uncomfortable sharing personal details with a total stranger. Whatever you decide, I hope that you get the medical help that you need and that you feel better.

-Rebecca

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