30A Shopper, we have discussed this before, but the easiest and most common example is the company that refuses to cover a certain procedure regardless of what the doctor says; the lack of coverage for pre-existing conditions; the fact that insurance companies (or the underwriters as they always say) refuse to pay for a mammogram if it has been less than 366 days since one was administered, regardless of what the doctor says; that if you have two eye exams that need to be done, they have to be done on separate visits, or the insurance won't cover them...bone density scans that are needed according to the doctor, for baseline information, but will not be covered unless there is a "medical necessity", at which time, there is already a problem that could have been prevented; all too often, it seems to me, the insurance company is making the decision for the doctor.
Perhaps some of this is that more procedures are covered for men than for women and children...I don't have any data for that, but I do know that many of the tests that are regularly covered for men as it has to do with heart disease, are not covered for women--I could go on and on, but those are just what come quickly to mind.
I have been fortunate to have good health; have always managed to have decent insurance, which I have paid for myself most of the time, as a self employed person; but there is little importance given to preventive health measures and for those people who may be sicker, or not as fortunate as I have been to have access to insurance, life can be pretty miserable when dealing with insurance companies; I think we should be able to do better in America for all people--not just for the most fortunate or the ones who are able to understand the deliberately confusing insurance world. I do not believe that making health care more accessible and more affordable for more people will take anything important away from me--a healthier society should benefit all of us. While there will always be those who make choices that do not make sense, and result in bad outcomes, I do believe the majority of people will do what they have to do to provide health care for their family--there are many right here in our area who daily must make a choice between food, mortgage or rent payments, and doctor bills--they survive from one day to the next and work everyday--I would much rather see some reform that would give these folks a break, rather than continue to see huge profits going into the insurance exec's bank account--when they already make $65 million a year, what's a few thousand here and there!
