DeniseCAHeathcare Status: Employer Insured
Our daughter was born with congenital heart defects and had the best of care when we lived in the Bay Area, however, we could only afford an HMO and learned we would have to fight to gain access to the top specialists for our daughter's care.
A couple years ago our daughter was diagnosed with a rare, life-threatening illness for which there is no cure and few treatment options, far fewer options for her because she is also a heart patient. Once again, we have to fight for access to a specialist in another state due to the lack of specialists in California. Our insurance company expects us to accept the fact that because we can only afford an HMO we are restricted to specialists at the only children's hospital in our city that almost killed our daughter in August 2007 because of their lack of expertise on her illness.
I find it appalling that 50% of health care costs go toward administrative costs and representatives, with no medical background whatsoever, are making life and death decisions! You need to realize you DO have a voice in the quality of care you receive. Insist on speaking with a Supervisor or Case Manager and bypass the representatives and do not be afraid to file appeal, after appeal, after appeal.
If you have to, go to the media with your struggle; we had to do it back in 1991 in order to bring to light the difficulty of changing health insurance companies when you are dealing with pre-existing conditions.
The actual amount of health insurance dollars that goes toward administrative costs is 35%. 25% on the insurers end and 12% in the doctors office.