Like many US workers, I receive health insurance via my employer; at a subsidized rate via a Cafeteria Plan. Over the past several weeks I’ve come to realize that insurance companies, for lack of a better and more professional word, suck.
My company switched from Cigna to Anthem Blue Cross this year and with it came new coverage’s and different rate plans. What we weren’t told was that all the pre-authorizations had to be done again; all those expensive prescriptions had to be reexamined to make sure they were approved by Anthem.
Here’s my frustration with the process of insurance companies. If I’m on a medication, for example, that I take daily that helps me function as a human being should and my doctor prescribed this medication that has no generic form, what place does an Insurance Company have to question that prescription and its diagnosis? Why do I have to jump through hoops to get my own prescription filled because an insurance company has to pay extra for a drug that helps me function?
Another example, a female employee with intense pain in her lower abdomen wishes to have a hysterectomy rather than going through the pain and lost work time of essentially taking one part at a time. She goes to her doctor in January and, after asking the Insurance Company for permission, the doctors says they can’t do it but if she wants to come back in May they can. Apparently the Insurance Company her spouse has only approves total hysterectomies after the first quarter of the year.
A truly personal example of the dysfunction that is our American Healthcare System, I visited the doctor a few years ago with intense pain, doubled over kind of pain. Confused as to what it might be, my doctor wants to run several tests to rule out a few things. The first thing he did was run it through the insurance company to see if they’d cover the tests he wanted to run to make sure I didn’t have Liver cancer, Liver. Cancer. I don’t care what the insurance says, run the test man. (I don’t by the way, clean as a whistle)
I understand that insurance companies are businesses and their primary function is to turn a profit. But at what cost? How many Americans that actually have cancer go without that test because their insurance won’t pay for it and they can’t afford it? How many women are enduring multiple surgeries all because the insurance company wouldn’t pay for a hysterectomy in the first quarter of the year?
I don’t know what the fix is for the American Healthcare system. The public option may be it or it may be a complete cluster, who knows. What I do know is that something has to give; the health of Americans should not be in the hands of an insurance company that is only out for a profit. My healthcare options should be between me and my doctor; not me, my doctor, the insurance company, and my employer.
What does this have to do with HR? Nothing really, other than I beg you to do your best to provide the best coverage you can for your employees; and make sure you know what the fine print says.
{ 4 comments… read them below or add one }
It has everything to do with HR.
- How do we attract the best & brightest candidates when crappy insurance is coupled with our total compensation plans?
- How do we pay a decent wage when employers are mandated to cover the cost of insurance?
- How does HR manage the compliance and legal issues when our companies get sued for breech of contract due to the legalistic and risk-adverse way we manage our self-insured plans?
- What about privacy implications?
It’s all HR, April.
Keep writing.
Should be breach of contract. I’m typing too quickly.
I bought all of the insurance for my (former) company, and Laurie is right: it has EVERYTHING to do with HR.
One of my selling points to potential employees (most were unskilled or semi-skilled low wage): My wages start low. They will get better the longer you are here. I provide excellent health benefits to make up for the lower start wage. (When I left the employees still paid nothing toward the premium, only their co-pays and deductibles. I reimbursed any hospitalization deductible/co-pay.) Think about that and decide if you might want to work here for the long haul.
I also completely disclosed to my employees how much their health insurance premiums cost the company every month. They understood what the company was up against when it came to costs.
I’m tooting my own horn a bit, but this is one of the reasons I loved working for a small business. It was easy to show the employees why the company was trying to keep them protected and still make enough money to keep them all working.
Yes, medical insurance companies suck. But if HR doesn’t get to have a voice in buying better plans, then the company has a problem, too.
@Laurie – You are 100% correct, I guess I was thinking more along the lines of my own person issues with healthcare. Recruiting good candidates is rough when your package includes an insurance plan that costs employees an arm and a leg up front. Getting them in the door is far easier than keeping them. Once they or a covered dependent has a medical issue and they are hit with deductibles and co-pays and ‘Your insurance doesnt cover that procedure’, that’s when they start looking elsewhere. Tieing employement to Healthcare just doesnt seem fair.
@Joan – That’s one thing I miss about working for a small company. In my previous life I was it, I negotiated the benefits and I fought tooth and nail for the best coverage I could get at the best price for my employees. And it was a selling point, a damn good one. If HR doenst have a voice in negotiating the benefits plans, someone is doing something wrong. But take for instance my case, benefits are negoitated at a corporate level and I have no say in the structure of them, despite my best efforts
It makes it hard when employees ask if there’s something I can do for them, and try as I might the answer is always ‘I’m working on it I promise’.