When Seeking Help is a Crime- the Failure of Insurance Carriers

Wisdom, something we associate with age, experience, and depth of intuitiveness. A quality esteemed, but not always understood as it should be. Many are taught from youth that wisdom is a prize to be awarded as you gather and collect enough information applicable to life, to avoid bad situations, solve challenges and enjoy greater success. It is looked at as a desired quality. The truth is, age does not guarantee the development of wisdom, nor desire to use it justly. People can contain wisdom from them and absolutely refuse to use it especially if that would require also sacrificing a comfort, or limiting financial gain.

The thought of old things being wise and better at what they do may be a bit disconnected. A sensei once said that “Practice does not make perfect. Practice makes you better. So be careful what you practice.” That statement caused me to completely re-evaluate my perspective on perfection, wisdom, and process of improvement. It also taught me to observe the world around me with a broadened sense of awareness. What are people practicing? What have they become better at?Not All Fails Are Cute-Puppy Fail It is true that for healthy growth and development some limited temporary tolerance for failure is warranted. Similar to a toddler learning the right way to tackle stairs and finding out up can be harder than down. Or a puppy wanting to carry a stick through a door and discovering not every stick is small enough to fit through. Those fails are expected during times of innocence. Holding that idea to its core, any business that has operated for 20 years should be very good at what they do. And it proves accurate, length of practice does yield strong results, having learned through trial and error. However, the results are not always favorable, and transitions such that those failures no longer appear cute and adorable. It boils down to intentional negligence

A swindler who has been at it for 20 years is an expert. Through years of practice, his/her skill in defrauding others gets better. So when you consider any health insurance carrier, what does their history show they have practiced. In one breath, ask anyone with a chronic illness or who has need of an extensive treatment, even if one time only, and you will hear…”denial”. Denial-InsuranceInsurance carriers have become experts at denying services. It is the singular most effective way to gain profit. Take your money, and control its benefit back to you through a series of intentionally complicated processes and clauses all with a focus that ensures their profit, and with little to no concern for your consequent health.

They are also just as good at denying their responsibility.  Denying their role in perpetuating the level of medical crisis in the US. Accountability is non-existent and in the rare case some are found, gets negotiated away, in secret with very few consequences for those most directly responsible. This overall knowledge is not a secret. The information has been in the open for far too long. But it’s hard to talk truth to power. Power just shuts off and skips to the beach somewhere, away from the bothersome dying thousands. So when my sons were recently denied services because they were deemed too sick, I was unsurprised. It was them in the first place delaying services so long the medical conditions surged and worsened. In addition, what they didn’t know was several tests had taken place to evaluate their fairness in applying their own policies claimed to be the guiding points for approvals.

The same authorization requests had been sent in, from multiple different people, coordinated through my support group. The same information attached, and if the rules were applied the same as they claimed, denials would be identical. But they were not. Proving, the carrier’s goal is to eliminate as much expense as possible. Each patient was real, all information valid, but preselected as a check and balance of level of trustworthiness. So nothing fraudulent was done. Every individual had the same needs, same basic diagnosis and the same level of documentation. Had approvals been granted, real patients would have been treated.

I am disgusted that the posturing of medical insurance carriers denotes asking for help is a crime.  Insurance carriers bottom line behavior convey we are some type of criminal to request treatment. Because of this, healthcare providers often treat patients like criminals too. Of course, this is symbolic wording, but the negative, nearly hostile, suspicious reception many of us get can be fairly compared to that. It really does come across as if we literally committed a felony. A prior authorization refusal is a big warning, don’t come around here again or else.

I have been a victim of domestic violence in my past marriage. During that time seeking help was intensely dangerous. The consequences of alerting anyone that all was not well within the home or marriage was met with incredibly powerful toxicity and emotional harm. Asking for help was treated as a crime and my children and I endured extensive berating as if we had held up a bank and embarrassed him. I recall the negative roadblocks he would put up to ensure his desires and wants came before others desperate needs. Sometimes that included preventing us from getting medical attention. So believe me when I tell you, having an insurance company treat you as if your needs inconvenience their holiday weekend, or that you just broke into their home and stole something is nearly identical. The similarity here is the abuse in the denial process.

Why is asking for help a crime? Why do we all know that something is wrong, yet it is allowed to continue? Those answers are layered in deceit and intentionally protected, but changing that system is the only way to save those in the most need. If you are reading this blog, and in a position to create change, you hold great opportunity in your hands. I encourage you to do so passionately and know, those of us in need appreciate every effort. Aside from that its the principle that eats at my soul of compassion. Who is really committing the crime here? Surely not the patient who just wants to finish their chemotherapy. obamacare-preventative-care-20170106

Accountability is a wonderful, effective antibody to systemic abuse. Whether it is an abusive spouse, parent, employer, or insurance carrier, accountability has the power to stave off the common practices that aid in harming others for profit. It really doesn’t matter if there was no initial intent. If the damage is known, resulting from one’s actions, then continuing to do it is intentional harm. Even if it was a crime to ask for help in some twisted demented alternate reality, they shouldn’t also be judge and hand out death sentences. That is the problem here, the denials are judgments come with life sentences too.

I wrote an article about Mastering Failure as a superpower. It is something I take seriously and failure should serve as a guide to improve lives, not make them worse. So if all is innocent and the failing just a sad circumstance, learning from it and implementing fail-safes to careless denials would be prudent. There are always exceptions to the rule. Occasionally you will find individual agents who follow justice and implement what they can to help. Some employers put in place clauses that ensure more expansive services for employees, and smaller independent insurance carriers have stated grassroots approaches to balancing profit to loss. They are out there, and some fighting every bit as hard to initiate change as I am. But those are too rare.

I can and will pray for a day when equality is the highest priority and caring is the goal. For now, however, Health Insurance Carriers treat asking for help as a crime and seem okay with living as a failure.—Pamela Juers

Author Pamela Juers
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