The More Things Change…

…the more they stay exactly the same.

Back in July 2008, HCAN partnered with PSA to made the following video called “Insurance Company Rules.” It illustrates the absurdity of health insurance companies’ tendency to make up the rules as they go along:

This morning – more than 2 years later – I had the pleasure of experiencing Insurance Company Rules firsthand.

I got an Explanation of Benefits in the mail a couple of days ago that made no sense. I see a doctor who charges me $125, and UnitedHealthCare reimburses me a percentage of that $125. Then the doctor ups her rate by $10, and UHC pays me the same percentage on the $135. That was as of 8/7/10. A week later, the allowance drops to $115.

I called UHC to find out why, and their reason defies all logic. They said their “usual and customary” formula allows a maximum of $115, and everything up until 8/14/10 has been a mistake. We’re talking about more than 10 months of mistake.

What happens next is unbelievable. Because I called for an explanation, UHC is now sending my account back to Claims to recalculate, and if I owe them money (which they will undoubtedly conclude), they will send me a bill for the difference. I’ll be punished for asking questions. If I disagree with their assessment, they say, I have the right to appeal. To them.

Since UHC’s formula seems to be more “flexible and arbitrary” than “usual and customary,” I’m officially instituting a little policy of my own. I’ll accept a letter informing me of their reimbursement rate moving forward, but I won’t indulge any effort to collect payments they say they “lost” due to their own 10-month miscalculations.

UHC doesn’t need more of my money. From the most recent HCAN report on CEO compensation:

CEO Stephen Hemsley of UnitedHealth Group banked $107.5 million in 2009, including $98.6 million from exercising stock options.

My premiums went up again a couple of months ago. No change in health status. No change in policy. Just a greedy health insurance company trying to squeeze every last dollar out of the little people. As far as I’m concerned – as far as this bogus claim is concerned – they’re not going to see a dime.

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