Healthcare reform: A personal tale

Our family is in good health and we don’t have huge medical bills to pay. Through my school, we have a good medical coverage — probably what they call as Cadillac plan — which we rarely need. So, it is unlikely that I have much insight on healthcare reform. But, now I do.

My health insurance provider, Blue Cross Blue Shield, offers its customers reimbursement of membership fees for gym in order to encourage heathy lifestyle. I think it is a great idea. It is lot cheap to pay to encourage healthy life style than paying for the medical bills once we get sick. Both my wife and I are members of local gym. I try to go there 2-3 times a week (but as I wrote earlier, I don’t like to follow my own rule). My wife, on the other hand, goes there every day. So, when she saw the announcement, she jumped right in. She went to the gym and asked for a copy of her access log, which amounted to several pages. She filled out the form and mailed it to Blue Cross Blue Shield. That was a few weeks ago. Finally, yesterday, I saw a letter from Blue Cross Blue Shield. Hoping that it must be the reimbursement check, I open the envelop only to find a rejection letter. The letter says that our “claim” has been “denied” since there is no document showing that we paid the membership fee.

Now, I can see why they can’t process the claim and send the check. We should have included a receipt or something that shows how much we pay for the membership. But, the letter sounds as if we were making a false claim: to collect membership fee reimbursement that we did not pay for. I wonder why they could not contact us (via e-mail, phone or letter) and tell us that “we need to know how much you paid.” Instead, they reject our claim. How could my wife access that gym almost 365 days a year without ever paying the membership fee? Duh!

Of course, this is nothing compared to other horror stories that I heard when people’s claims were denied for some unknown pre-condition. It is not like that we have to pay tens of thousands of dollars for medical bills. After all, all we can get probably is less than $200 at most. But, what it tells us is how these insurance companies operate and their mindset. It is the basic attitude that we will find any reason not to keep our promises. It is a microscopic experience that I had that seem to reveal what is going on in a much grander and more serious scale.

Professor | Writer | Teacher Digital Innovation, Design, Organizational Genetics Case Western Reserve University

One thought on “Healthcare reform: A personal tale

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