Tuesday, November 14, 2006

Insurance Verbage

I'm shopping for insurance. Our current policy costs significantly more per month than I bring in. Literally. It would be financial suicide to continue it. So I'm looking for something -- anything -- that will make it possible for us to have some sort of coverage.

No one in our family smokes, is overweight, has high blood pressure, is infested with a communicable disease, or flies jets. For some odd reason, however, the insurance companies are a bit balky about insuring my husband. The whole seizure thing really makes them nervous.

I fail to understand how the insurance industry gets around the Americans with Disabilities Act. According to the official ADA website:

the ADA prohibits discrimination on the basis of disability in employment, programs and services provided by state and local governments, goods and services ...

It's the "goods and services" clause that gets me. Anyone who has ever shopped for insurance knows that the industry is BUILT on discriminating on the basis of disability... and gender... and age... and weight... and Acts of God...

I especially love the small print in insurance policies that tell you what your premium WON'T get you. Here's an actual, verbatim excerpt from a company that assured me it did, indeed, want my business, and that it could provide me with the best possible policy for me and my family:

There are no benefits for pregnancy, mental and emotional disorders, or chiropractic care. Organ transplants performed in a designated transplant facility have a $1,000,000 lifetime maximum; in a non-designated transplant facility, there is a $150,000 lifetime maximum. The plan also includes utilization review, which requires notification of hospitalization.


What creative writing skills went into that bit of text, eh? (I know: sarcasm doesn't translate well into print. Can't help myself...)

I especially love the phrase There are no benefits for pregnancy. I look at my three year old daughter and beg to differ with whoever penned that gem.

I also love how pregnancy, mental illness, and a bad back are grouped together as if one had anything in common with the others.

Finally, you gotta love an industry who tells you not only where on the planet you can have your heart transplant, but that also requires you to notify them of when you intend to be in the hospital for said procedure.

To my knowledge, recipients of organ transplants are not generally in a condition that allows them to fly about the country to "designated facilities." They also rarely get the opportunity to schedule their procedure.

Image the realities of the policy:

"Oh -- my lungs are ready! ::wheeze:: Great! When? No, no... That's not good for me.

Besides, I can't have the transplant done there. I mean -- $150,000 won't even cover the surgeon walking through the front door, now, will it? I need you to put the lungs on a plane and send them ::gasp:: to... I've got the address somewhere.

Ooo, but before you do that, I need to notify my insurance of my intention to be hospitalized. they need to ::aaahhhh::: do a utilization review of my case. Just stick them on ice, I suppose. I'll get back to you.

On a final note, I also received this inspired bit of business:

For your husband, we recommend the XYZ health plan through ABC Company. There is a lifetime benefit of $5,000,000 per insured. Maternity is covered with this plan.

I can't tell you how comforting it is to know that an insurance company exists that will cover Robert in the event he becomes pregnant. And here I was, thinking that the insurance industry was going out of its way to be obtuse, murky, and difficult. Who knew?