Everywhere I turn, I hear that healthcare is going to be rationed! Bureaucrats are going to get between me and my doctor, and my choices are going to be taken away from me! So, I decided to find out for myself. After combing through hundreds of pages of complicated PDFs written in mind-numbing legal speak, I discovered that the rumors are TRUE! Incompetent bureaucrats with no medical training really ARE going to be the deciding factor in whether I receive the services my doctor recommends, and the ominously-named “Plan” really IS going to tell me which doctors I can and cannot see!
This is terrible, just TERRIBLE! Clearly this “Plan” must be stopped- and soon- before these evil paper-pushers send me and my family before some twisted death panel to decide whether I am worth the treatment they dole out. Don’t worry though- I have copied some of the most terrifying prospects from this hideous document so that you can be fairly warned about what is coming to you!
“Please remember that all benefits are subject to the definitions, limitations, and exclusions… and are payable only when we determine they are medically necessary.”
“Not covered: Any part of a hospital admission that is not medically necessary (see definition) such as when you do not need acute hospital inpatient (overnight) care, but could receive care in some other setting without adversely affecting your condition or the quality of your medical care.”
[Preceding “Section 6. General Exclusions- things we don’t cover”]
“The exclusions in this section apply to all benefits. There may be other exclusions and limitations listed [previously in] this brochure. Although we may list a specific service as a benefit, we will not cover it unless we determine it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or condition. The fact that one of [your doctors] has prescribed, recommended, or approved a service or supply does not make it medically necessary or eligible for coverage under this Plan.”
See, there it is! I didn’t even have to add the bold- it is really in there. These nasty thugs are going to be the ones who make my medical decisions for me, with no regard for whatever advice my doctor gives me! Even the things they say they might cover, they reserve the right to steal away from me if they don’t think I am worthy of their “care.”
“Medical necessity [definition] Services, drugs, supplies, or equipment provided by a hospital or covered provider of health care services that we determine: 1. are appropriate to diagnose or treat the patient’s medical condition; 2. are consistent with standards of good medical practice in the United States; 3. are not primarily for the personal comfort or convenience of the patient, the family, or the provider; 4; are not a part of or associated with the scholastic education or vocational training of the patient; and 5. In the case of inpatient care, cannot be provided safely on an outpatient basis. The fact that a covered provider has prescribed, recommended, or approved a service, supply, drug, or equipment does not, in itself, make it medically necessary.”
Here is their sinister definition for what basis they will determine “medical necessity” upon. The key thing here is those three little words, “that we determine.” We, as in the “Plan.” Also note that they do not give any standing to the comfort of me, my family, or my doctor. However, they do not include the comfort of the “Plan” in their little ploy. Their comfort, I guess, is a perfectly legitimate reason to deny my claims.
“[Preferred] benefits apply only when you use a [preferred] provider.”
They are taking away my choice to use whichever doctors I prefer! They want to be the ones who decide where I can go and who I can see. And let’s be honest- we are not stupid! Their “preferred” providers are the ones who are willing to capitulate to their petty, greedy demands. They may not be the best qualified to take care of my specific needs, but they are the ones I get. Sigh.
“We cover one routine physical exam and one routine gynecologic exam for women age 18 and older, per calendar year.”
“We cover… diagnostic tests related to one routine physical exam… per calendar year. Non-routine or more extensive tests as determined by the Plan are not covered under this benefit.”
[Regarding maternity care]
“You may remain in the hospital up to 48 hours after admission for a regular delivery and 96 hours after admission for a cesarean delivery. Not covered: Routine sonograms to determine fetal age, size, or sex; stand-by doctor for cesarean section; services before enrollment in the Plan begins or after enrollment ends.”
See here! Rationing! This is it! I can only go to the doctor once per year, and I can only get tests that they deem to be “routine.” If something comes back unclear or problematic, they will not allow me to get the tests I need to determine the problem! They probably figure that if I get further testing and my doctors find a serious condition, they will have to dole out more money… and I’m just not worth it to these filthy bureaucrats.
“YOU MUST GET PRECERTIFICATION FOR SOME SURGICAL PROCEDURES.”
The caps here are all theirs. They want me to get permission from this Big Brother “Plan” of theirs! See, once again they prove that they are only interested in getting involved in MY personal healthcare! They are unfairly inserting themselves between ME AND MY DOCTOR!
So, guys, can you see what trouble we are in?? I mean, I heard people screaming about this stuff, but I figured they were just you friendly neighborhood fringe lunatics. Until now- until I looked it all up for myself!
Here it is… definitive proof that the FOR-PROFIT INSURANCE INDUSTRY is full of bureaucrats who want to make medical decisions which override the best recommendations of your doctor, limit your choice of providers, and require you to seek permission to receive their services. Healthcare will be rationed… if we keep our system the way it is.
All of the above quotes were taken directly from a (relatively good) privately run employee benefits plan which is offered by a job I am pursuing.
