The Dangers of Having Great Health Insurance

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On occasion, in a conversation with new acquaintance, they’ll ask me what I do for a living. I tell them I established and run the most comprehensive directory of independent, private health and patient advocates and care managers online, supported by a marvelous professional organization whose members populate the directory.

“Independent and private?” they ask me. “I don’t need an advocate like that because I have great health insurance!”

“Oh but you’re wrong!” I reply.  “In some ways you need an independent advocate even more than someone with lousy insurance does!”  I then go on to explain why.

Remember, the entire healthcare system of the United States is based on money. Every aspect of medical care is focused solely on parting us patients and health individuals from our money. The more ways they can think of to suck money from our pockets, and the more opaque they can be about that process, the happier the system, and the unhappier the patient.

That word “opaque” is important because it is there that so many people don’t realize what is happening to them.  When they don’t realize it, then they don’t recognize the dangers to their health and to their wallets, too. Those with “great” health insurance are especially vulnerable because they think their care isn’t going to “cost” them anything – so they go along with it all.

Going along is dangerous to their health and their wallets.

Here are some examples of the health dangers of great insurance:

Jeff B. was hurt in a dirt bike accident. He works for a large employer who offers good health coverage, so neither he nor his wife gave much thought to the care Jeff was receiving. As a result, he received treatment he didn’t really need, including multiple x-rays (when one set would have been just fine) – which exposed him to radiation poisoning. Surgery was recommended – and it turned out to be unnecessary. Further, Jeff’s doctor prescribed opiates for his pain, Jeff became dependent on them, and now his pain is far beyond what it should have been and he’s dealing with withdrawal, too. He hurts, he feels desperate, and so far he hasn’t been able to return to work OR get disability payments.

Jeff didn’t know the questions to ask. Jeff didn’t understand the ramifications of letting the doctors do everything the doctors wanted to do. Jeff didn’t realize he would be backed into a corner by “great” health insurance. Jeff needed a professional patient advocate by his side to make sure his experience went smoothly and that his circumstances would allow him to heal properly.

Maxine has experienced a great deal of stomach upset. Because she has such “great” health insurance, she continued to go back to her doctor (after all, it didn’t cost her anything) because none of the treatments she was prescribed seemed to relieve the upset. Her doctor sent Maxine to a gastroenterologist who couldn’t find any problems. Finally, Maxine was in such pain, she was hospitalized, only to discover that she had Stage 4 Ovarian Cancer. From her first doctor visit to her hospitalization was a period of six months. Her lack of treatment in those six months resulted in her death just a few months later because she wasn’t treated in time to save her.

Maxine relied on her own lack of knowledge to make choices along the way because she had “great” health insurance and didn’t question what she was being told. Maxine needed an independent, professional health advocate to guide her, to get her to the right doctors (gynecologist or oncologist) – right away. Ovarian cancer is treatable when it’s discovered in time. Maxine lost her life to trusting her doctors because she had “great” health insurance.

Richard, an 80-year-old retired executive, had retired with “great” health insurance. He had been diagnosed with prostate cancer decades prior, but had kept it under control all those years (called watchful waiting.) When he suffered from back pain, he sought out a back surgeon who assured him that back surgery would relieve his pain and would allow him to live pain-free for the rest of his days.

In this case, Richard had a good advocate, one who insisted he get a second opinion, one who found several studies online that suggested the surgeon wasn’t being entirely truthful, one who (along with the rest of his family) asked him to rethink his decision to have the surgery, to at least make the decision based on facts, and not on wishful thinking. Despite all that, Richard went forward with the surgery. A year later he died, never having relieved the pain, suffering from new pain that resulted from the surgery, and dying from the metasteses to his bones – the prostate cancer having spread post-surgery.**

*Maxine’s story represents my mother-in-law who suffered and died from exactly these circumstances.

**Richard was my father, who despite my advocacy work for him, and despite my sisters imploring him to rethink his decision, went forward anyway. When the surgeon saw Dad coming, with his “great” health insurance (Dad’s retirement insurance paid surgeons top dollar, and cost Dad only $3 out of his pocket) big, impossible promises were made as the surgeon salivated over the prospect. Dad, desperate to find relief, caved to wishful thinking – and suffered more because of it.

So that’s today’s lesson:  Just because you have ‘great’ health insurance doesn’t mean you will get the best of the system.

Don’t let your story be another example. No matter what kind of health insurance you have, don’t go it alone. Find a health or patient advocate or care manager to hold your hand and help you find the best of care.

 
 

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Comments

  1. Anne Llewellyn  April 30, 2017

    Could not agree more Trisha. Health Insurance gives you access to healthcare, but it might not be the best. Being an active part of your healthcare team is a role each person has to take seriously. BUT, being an active member is not as easy as it sounds and having a person, an advocate who can listen, remind you to ask the questions you have and opt for care that meets your goals is something we all need to keep in mind. Health/Patient Advocates are available to help people have a voice and work with the healthcare team on your behalf. As a nurse of over 40 year, I am alive today because of the advocates I had who helped me when I was diagnosed with a Brain Tumor. That experience left with with the reinforced belief that every patient needs an advocate when they are thrust in the healthcare system.

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