At least once or twice a week, one of our staff people will observe me at my phone, fist clenched, smoke rushing from both ears, my feathers clearly ruffled. I\u2019m told I also sound a bit like Gilbert Gottfried, but I think that\u2019s unfair. So what is it that\u2019s setting me off?<\/p>\n\n\n\n
Well, folks, it\u2019s just me smoldering in conversation with a fellow physician or a nurse, sometimes even a pharmacist. And before you think I\u2019m \u2018fessing up a personality disorder you didn\u2019t know about, let me add that these are not just random health professionals. These are the well-salaried professional prostitutes of insurance companies.<\/p>\n\n\n\n
More than once I have resisted the urge to ask if they happen to be working while lying on their backs.<\/p>\n\n\n\n
First, let me remind you of the health and disability insurance company game plan. The company collects your money (in the form of a premium). If you\u2019re an individual policy holder, you pay 100%. If you\u2019re part of a group, your employer covers a certain percent, you the rest. As long as you stay well you feel confident that you\u2019re protected should you become ill or disabled. Most of the time, despite some unexpected out-of-pocket expenses, and considering its size (with hundreds of thousands of claims to process daily), the health insurance process goes remarkably smoothly.<\/p>\n\n\n\n
Then the \u201cuh-oh\u201d occurs.<\/p>\n\n\n\n
When Dr. Rubin and I were purchasing health insurance for our practice, our agent asked us about getting disability coverage, both short-term (three to six months) and long-term (usually six months to five years). \u201cWhy would we bother?\u201d one of us said. \u201cThey never pay out benefits to anyone. When you try to make a claim, they make you crawl through the mud then they turn you down.\u201d Wisely, the agent said \u201cLet\u2019s move on to property and casualty.\u201d<\/p>\n\n\n\n
Virtually every case of short-term disability (say a wrenched back, a slipped disc, a flare-up of fibromyalgia) is assigned a case manager, usually a nurse, who exists to obstruct your claim and humiliate you in the process. Here\u2019s the usual sequence of events:<\/p>\n\n\n\n
Then\u2026crickets. Nada. Nothing.<\/p>\n\n\n\n
Remember, you\u2019re too sick to work, but you marshal the strength to begin making follow-up phone calls to find out where your payment is. And humans never answer. You leave voices messages. Nobody calls you back.<\/p>\n\n\n\n
Finally a connection is made. \u201cOh,\u201d the nurse\/manager chirps, \u201cWe do have your paperwork. Your doctor never sent his xyz (or filled the forms incorrectly, or whatever).\u201d A total lie, of course, and we have the fax receipt to prove it. This is a standard delaying tactic and it can go on for weeks, while you\u2019re both ill and rapidly going broke. You\u2019re also under pressure to return to work.<\/p>\n\n\n\n
So you fill out more forms, we photocopy your chart, dictate a narrative report. And the final results are rarely good news. No shortage of patients have told me \u201cI could tell the nurse didn\u2019t believe I was ill. All she wanted to do was look for loopholes so the company could get out of paying me.\u201d<\/p>\n\n\n\n
Finally, out of sheer financial desperation, you return to work, inadequately rested. You give up trying to collect, since it\u2019s all you can do to get to the job and do what you\u2019re being paid for. Phone them again and again, every day? You must be kidding.<\/p>\n\n\n\n
The disability insurer has won again. And, if you can imagine, it\u2019s even worse if you\u2019re applying for long-term disability, which kicks in after short-term disability \u201cbenefits\u201d expire. Usually this is a separate insurance company, so all the form filling and record transmissions begin anew. For long-term disability cases, companies usually assign both a doctor and a nurse. Not uncommonly, they also hire an investigative agency (yes, that\u2019s right, a detective) to take photos of you if you go out shopping or walk your dog, \u201cproving\u201d you\u2019re not really disabled if you can walk your dog.<\/p>\n\n\n\n
It\u2019s when I\u2019m in conversation with the health professionals who supervise long-term claims that my blood boils. Since an insurance company profits by not paying<\/em> benefits, it hires legions of these physicians and nurses to put a patina of professional expertise onto the denial process. This covers them legally should the claim ever to go to court (which it virtually never does). The vast majority of patients simply accept defeat. They\u2019re tired and ill and it\u2019s just too expensive to fight.<\/p>\n\n\n\n My conversations with these industry shills over the years have been amazing.<\/p>\n\n\n\n Insurance doc (ID): \u201cYou\u2019re saying she can\u2019t work because of pain. Can\u2019t you give her a pain med?\u201d \u201cIt is difficult to get a man to understand something when his salary depends on his not understanding it.\u201d<\/p>\n\n\n\n A couple of weeks later, both the patient and I receive an official-looking letter documenting in a series of bullet points (including \u201cno positive blood tests\u201d) why the claim for disability has been rejected.<\/p>\n\n\n\n This is when I get really irritated.<\/p>\n\n\n\n I\u2019ll call back the doctor or nurse who signed off on this letter even though I know we\u2019ve pretty much lost the case. Nevertheless, out of sheer exasperation, I\u2019ll remind them that when they applied to medical or nursing school, they likely wrote an essay about why they wanted to become a doctor or nurse. The most common sentence applicants write is \u201cI want to help other people.\u201d The second, \u201cI want to make a positive difference in the world.\u201d<\/p>\n\n\n\n So I have to call and ask, \u201cAren\u2019t you bothered by what you\u2019re doing? Doesn\u2019t it affect you that you\u2019re harming actual lives by selling yourself out like this?\u201d (I naturally hold off uttering the ultimate blurt, \u201cDo you do this job while you\u2019re lying on your back?\u201d)<\/p>\n\n\n\n The usual response is variation of \u201cthat\u2019s uncalled for.\u201d<\/p>\n\n\n\n \u201cBut it\u2019s not uncalled for at all,\u201d I tell them. \u201cYou\u2019re getting a financial incentive to adversely affect people\u2019s lives. This is bad karma.\u201d<\/p>\n\n\n\n Nothing\u2019s ever really gained. They virtually never reverse their decision. But at least I feel better.<\/p>\n\n\n\n And bad karma or not\u2026I hope they feel worse.<\/p>\n\n\n\n Be well,<\/p>\n\n\n\n David Edelberg, MD<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" At least once or twice a week, one of our staff people will observe me at my phone, fist clenched, smoke rushing from both ears, my feathers clearly ruffled. I\u2019m told I also sound a bit like Gilbert Gottfried, but I think that\u2019s unfair. So what is it that\u2019s setting me off? Well, folks, it\u2019s […]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,10,203,3],"tags":[1406,1407,202],"class_list":["post-4938","post","type-post","status-publish","format-standard","hentry","category-blog","category-d","category-health-insurance-issues","category-knowledge-base","tag-disability-insurance","tag-doctor-and-nurse-prostitutes","tag-health-insurance"],"yoast_head":"\r\n
Me: \u201cIf I control her pain, the meds make her groggy. She can\u2019t think.\u201d
ID \u201cCan you lower the dose? I don\u2019t see how pain can\u2019t be controlled. \u2026and you mention \u2018fatigue,\u2019 I mean she just sits at a desk. Could you explain why somebody who\u2019s tired can\u2019t work? I mean we\u2019re all tired aren\u2019t we? Did you say she has fibromyalgia? I don\u2019t see any blood tests here\u2026\u201d
Me: \u201cThere are no blood tests for fibromyalgia..\u201d
ID: \u201cDon\u2019t they really think fibromyalgia is all psychological? That\u2019s what I\u2019ve read. I mean really. No x rays, no blood tests. I think she could go back to work…\u201d
Me: \u201cMay I ask what you\u2019re specialty is?\u201d
ID: \u201cI\u2019m a retired radiologist, but I don\u2019t think that\u2019s relevant.\u201d<\/p>\n\n\n\nMuckraker Upton Sinclair put it well more than 100 years ago<\/strong>\u2026<\/h3>\n\n\n\n