Oxford, my health insurance company, notified me today that they’re declining coverage for 2 of the 8 physical therapy visits prescribed for my back problems.
“After careful consideration of all the available information, it has been determined that 2 of the 8 visits requested will not be covered at this time for the following reason(s): The clinical information submitted was not sufficient to make a determination of medical necessity for visits beyond those approved at this time.”
Translation: We came up a little short of our obscene profit predictions for this quarter, and it looks like we can extract a bit more money out of you since you pay your co-pays on time.
Now, consider the numbers:
$6300: Total premiums paid for me since I started being a member 14 months ago. $170: Two visits to my doctor, one for a serious illness and one for severe back pain that’s lasted a year. ($20 co-pay each) $120: One visit to a back specialist, referred by my doctor, in-network. ($30 co-pay) $60: Two prescriptions for my back. ($10 co-pay each) $45, 8 times: Physical therapy for my back, prescribed by the specialist. ($30 co-pay each)
Oxford has paid $710 in claims for me. They’ve made a $5,590 profit so far, or 89% of my premiums.
I’ve paid $360 in co-pays.
Now they want another $90, and since they’re a health insurance company and it’s too small of an amount to sue over, I have no choice.
Health insurance is legal extortion that allows private enterprises to control the lives of the entire middle and lower class of the United States while making obscene profits and buying as many politicians as necessary to keep the system going.
I’m lucky enough that:
- I have health insurance to begin with
- this isn’t life-threatening
- I can afford the co-pays
- they haven’t dropped me yet
What about the people who don’t meet those criteria?