By Deborah Jeanne Sergeant
I am my mother’s healthcare proxy and manage her health insurance.
Imagine my surprise when I received an email from Optum Home Delivery Pharmacy, operated by UnitedHealthcare, stating all of her prescriptions with them were canceled.
Of course, I immediately called UnitedHealthcare.
The call center employee had no idea why I did not know United no longer offered her policy — not just the online pharmacy service — and that her policy had been canceled two months prior!
All of her mail, calls and emails related to these matters go to me.
I had two weeks to find her a different policy before her special enrollment period ended. And anytime during the weeks her coverage lapsed, she would have only basic Medicare, paltry coverage at best. But don’t worry! They’re “sorry for the inconvenience,” a phrase which naturally solves all of my problems.
Thankfully, Theresa Cangemi with Retirement Health Plans Made Simple in Brewerton was able to Zoom right away and guide our selection of the right plan.
Obviously, it was not a plan with UnitedHealthcare.
If you have enjoyed wonderful service from UnitedHealthcare, good for you. The above example is one of the tamer stories I could offer of a dozen such accounts. Dropping my mom’s coverage after years of faithful premium payments was the last straw. And it was emblematic of a healthcare system that is broken.
When receiving care, patients wait too long and pay too much. Their insurance companies provide too little coverage and charge too much. Customer service? It no longer exists.
George Chapman views a national health insurance program as the answer — and believes that America is ready for it.
“The resistance by the American Medical Association is almost nonexistent,” Chapman said. “A major reason why we didn’t have national health insurance up until 20 years ago is the AMA was dead set against it. That’s changed.”
Now retired, Chapman operated G.W. Chapman Consulting as a hospital consultant. He explained that because major hospital systems have purchased most independent providers’ practices (thanks in part to onerous insurance red tape), these providers no longer have to worry about billing. These large organizations have a robust billing department to chase down payments. But receiving payments from a single source would streamline their work.
“Office practice managers usually run the systems, they say Medicare runs great,” Chapman said. “The fees and rules are laid out. They have no problem with basic Medicare but then they have to deal with Advantage plans. The denial rates are much higher because Medicare is nonprofit.”
National health insurance may sound like it would raise premiums and prices for services since it would eliminate competition. However, Chapman said that every commercial insurer pays Medicare rates and for that reason commercial insurance isn’t needed.
“The biggest opponent keeping us from national health insurance is Big Pharma,” Chapman said. “They’re scared to death of national health insurance because all drug prices will be negotiable, not just 10. The pharmaceutical lobby is doing everything in its power to make sure it doesn’t happen. If you take away the drug lobby you’ll have national health insurance a lot sooner.”
Chapman also believes that patients would benefit from national healthcare.
“We have no healthcare system,” he said. “There’s no system. There are individual systems. This is what’s driving private providers out of practice.”
The difficulty in filing insurance claims and receiving sufficient reimbursement has all but eliminated independent practices.
It’s also likely that coverage representation would broaden. Gone would be the days of paying higher out-of-pocket rates for providers offering care outside the network since the network would not exist.
“National healthcare covers the whole United States,” Chapman said.
