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Spokane, Washington  Est. May 19, 1883

Opinion

Jamie Tobias Neely: Is the doctor in? Let me know

Jamie Tobias Neely The Spokesman-Review

So, a trio of health insurance folks trooped into our offices for a little chat this week.

They extolled the virtues of their particular company and advocated for more-or-less free market solutions to the health care crisis. They also promoted such ideas as “timely watching and waiting” on the part of doctors, a greater sense of awareness, particularly regarding the costs of various procedures, on the part of consumers, and more gratitude in general for the health insurance benefits we actually do receive.

At one point in the conversation, I asked about the issue that I’ve heard my friends discussing in recent years. A batch of moms, both active-duty and those now hovering over empty nests with an eye on the e-mail and a hand on the phone to inquire about all that new flying and dipping and soaring going on out there, we’ve become intimately aware of the health care realities faced in our own families.

There are many aspects of this mess that concern us: the high costs of pharmaceuticals and the inscrutable mysteries of co-pays, preferred drug lists and constantly changing formularies. The coverage gaps of America’s employer-sponsored system leave even some of our college-grad kids lacking coverage.

But the question that floated into my brain that day was this: Why do I hear so many stories about insurance companies denying legitimate claims, apparently just to confound the consumer into going away?

If that’s the case, it certainly doesn’t endear consumers like the mothers I know.

The insurance company execs sounded aghast at my question. Not at their company, they pledged. That simply wouldn’t happen to the people they insure.

Hmmm, I thought. There’s my perception that this practice isn’t uncommon. There was their perception that it is.

So, who is right?

This week Michael Moore’s new movie, “Sicko,” is receiving big publicity. As you might expect, Moore is no more a friend to the American corporation in this film than in any other.

One of the film clips on his Web site this week describes the practice of arbitrarily denying claims. A man’s voice says, “The intent is to maximize profits.” Moore says, “You denied more people health care, you got a bonus?” A woman answers: “When you don’t spend money on somebody, it’s a savings to the company.”

That’s Michael Moore’s world. It doesn’t seem to line up with the insurance execs’ reality. Does it match your own?

I’d like to hear about it. Please send me a brief description of your recent health care claims that appeared to be denied for no logical reason.

I’d also like to hear about other aspects of your health coverage that simply complicate your life and consume way more time than they should. Do you find that’s the case with the paperwork required to keep track of out-of-pocket medical spending? Do you find a health savings account more trouble than it’s worth? And what about the extra time required to chase down current formulary lists and make sure your doctor knows which drugs are on your insurance company’s thumbs-up list this week?

Perhaps you’ll simply want to say: “No, Jamie, all of these aspects of my current health care coverage leave me feeling empowered and deeply grateful for the benefits I receive. I’m healthier, happier, and ever more convinced that my family and I are incredibly fortunate to enjoy America’s current system of health care coverage.”

Surprise me. I’m all ears. And my contact information is listed below.