The Flaw of For-Profit Insurance

It accentuates the structural flaw plaguing Medicaid, which often sees enrollment spike during bad economies when states can least absorb the extra costs.
~ from Dems: Potential Cuts to Medicaid Outlined by Administration 'Cruel' by Mike Lillis ~

The structural flaw identified above is, in my opinion, THE structural flaw of for-profit insurance. When you don't have any claims to file, insurance companies love you. Unfortunately, when you need their services for an accident, injury, illness or death, then they often don't want to have anything to do with you!

For-profit insurance corporations make their money when we pay in and don't need them to pay out. So, to keep profits up, they come up with all sorts of reasons NOT to pay out -- even for the very benefits we've been paying them for in the first place.

Almost anyone you talk to has their own horror story when it comes to needing an insurance company to hold up their end of the bargain and the insurance company doing everything possible to evade their contractual responsibilities. My story concerns my mother.

For years, she dutifully paid her monthly health insurance premium. The insurance reps were always friendly and helpful, particularly when my mom was thinking about adding some increased coverage -- coverage that meant a higher premium!

One day my mother was diagnosed with multiple myeloma, a very serious form of cancer. All of a sudden, the ever friendly insurance reps weren't as friendly as before. Though my mother was hospitalized in a weakened condition, they hassled her constantly. They kept claiming that required forms had been lost or misplaced and that my mother had to resubmit them.

They were slow on paying claims and, in the interim, my mom kept receiving these huge bills from the hospital and the various medical professionals working with her. This prompted mom to call the insurance company to see what the problem was and, as is all too typical, she spent week upon week receiving one runaround after another.

But the absolute worst of it is when the insurance company threatened my mother's employer, an Area Agency on Aging (AAA). The AAA was told that, if they didn't drop my mother from the agency's insurance plan, the insurance company would drop the entire agency!! In other words, if my mom's employer didn't cut her loose in her time of need, all my mother's coworkers would lose their health insurance as well!

Talk about audacity. Talk about unfair play. Talk about unmitigated greed. I was so infuriated that I wanted to find the insurance company's CEO and rip him a new asshole and my anger was mild compared to my brother's!!!

Fortunately, the agency's lawyers and a judge stopped the insurance company from doing the unthinkable: victimizing a fully paid up customer for having the utter gall to succumb to disease.

I've always wondered if the insurance company bigwigs threw a party when my mom subsequently died. Hey, no more money to pay out for this sick woman -- that's what they wanted all along.