Insurance Companies That Don't Insure...
This particular post is about HealthNet, a California HMO that is refusing to cover treatment for a small boy with a rare bone disorder. But, as we all know, this could be any HMO anywhere in America. In this case, the only specialist with the experience to handle the disorder works at a children's hospital in Deleware, and obviously it's outside of HealthNet's network. The family knows there son will die without treatment. HealthNet knows it because their own specialist at the University of California of San Francisco concurs and has told the HMO as much. So what happens? Many months, 4 appeals of HealthNet's decision, threats of a lawsuit, and an expose in the San Francisco Chronicle finally get HealthNet to change their position.
OK...so here's the thing. There's an argument to be made that HealthNet can limit the type of care that they provide and where they provide it. There's an argument to be made that when the standard of care isn't adequate and the situation grave, the health care provider should come through. But I'm interested in something else.
Consider how much time was money was wasted by HealthNet in trying to get the family to give up. "Oh sure," you say, "...treatments like this are expensive and that's what's driving up health care costs." But maybe, just maybe, what's driving health care costs is the horrendous waste: Time and effort wasted by HMO administrators in denying the family's request; Time wasted by the UCSF specialist who saw the boy more than once and reached the same conclusion each time; Time wasted by the family and stopgap treatments that were wasted when HealthNet eventually relented.
When an insurer (or an health care provider) spends more time figuring out how to not care for you than they do actually caring for you, should we as a society draw the line and say, "Enough! Provide the care, or find another business to be in"?
Want to know why the health care system in this country doesn't work? Look no further than the waste.