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  • a happy, ordinary, middle-aged, suburban woman who paints odd pictures, gardens in a straw hat, lives with the love of her life, is owned by one cat and the ghosts of several others, and walks a little funny 'cause she has a fake leg. She started this website because there's more to life than what we lose, and we need to let each other know what's possible, even if it's only a happy, ordinary life.

November 2011

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A comment from the insurance gambler who "won" a bundle by trauma...the insurance companies were the very first folks to call me upon discharge from the hospital asking if there was a pending lawsuit (wich there is), and if a scale tips in my favor, they get first dibs AND they can still deny me insurance as I now have a "pre-existing condition". Talk about intricately laid out!

PS...dig your NaBloPoMo seal, girl!

Ron Sullivan

Bonnie, that's a trap of sadistic genius. Gotta hand it to the (insert obscenity here)s.

Two more notes about insurance: Once upon a time, e.g. when Wallace Stevens was doing it, selling insurance was one of those do-gooder jobs, like social worker or nurse. How times change.

I catch Blue Cross/Shield -- or, to be fair, Joe catches them because he handles insurance stuff mostly -- all the time in the act of gaining vis incompetence. If the current person in the minimum-wage job in Red Bluff knows little enough, and so does her supervisor, it gets frustrating trying to get bills and benefits straightened out, and a less dogged person then Captain Dogged Himself would give up and drop the matter. These incidents invariably are about money the company owes, rather than anything we owe them.

You know what's become even worse? Federal worker's comp. It's scary -- and one of these days I'll have to get that story written (not by me) somewhere.


Yes, Bonnie, because of the special circumstances at your particular table, you have also been given a copy of the Milton Bradley home edition of another popular game, Civil Litigation. This is a very, very difficult game, very time-consuming, expensive, and fraught with physical challenges as well, and many people are surprised to discover once they enter it how few of the other players are interested in concepts like justice or fairness. Besides being eager to place a judgment lien on your lawsuit or even enter it as a separate party, what you might not know is that if you had not filed a suit of your own, depending on the circumstances, it is entirely possible the insurance company would have filed one itself and you would have been required to make yourself available for depositions and medical examinations. Why? Because the insurance company is entitled to protect its profit growth.

Ron, yes, Bonnie's, as she calls it, California "big box insurance company" who's name rhymes with "miser" is a diabolical cesspool in my opinion, though it is not just her case which makes me think so. Her case is good enough fodder for this opinion, though. Her wheelchair was almost repossessed out from under her ass recently because of a "snafu" on their part, plus a nicety of their policy which seems to say that she can have a wheelchair or a prosthetic leg, but not both. The amount of money this company spends advertising itself as an institution devoted to caring for people could buy wheelchairs and prosthetic legs for many, many people. That's where the money is going, not to competent staff.

And I am quite certain you are so right, that the company is in effect placing a side bet that if it spends as litle as possible being competently and efficiently staffed, most claims or complications that might arise from them will evaporate. Though the insurance company covering me when I gave up my leg was United HealthCare, and the insurance company supposedly contracted to provide me short- and long-term disability coverage in the event of such a traumatic incident was CNA, I have experienced with both of these companies exactly the syndrome you have described. I even had a woman at CNA tell me that CNA was entitled by HIPAA -- which, and I quote directly, she told me was "all the fault of the Democrats, I believe" -- to ask me to waive privacy over such a blanket range of things that it included my history of drug and alcohol use, AIDS status, even my college and Social Security records, before processing my claim for a month of benefits (which equated to my projected number of working hours missed for that period paid at a percentage of my then-rate of pay, $8.50/hour) after I hurt myself and was ordered by an ER doc to sit down with my leg up for six weeks. Because I worked for lawyers for 18 years and have actually read HIPAA, I know this to be a complete lie, and I told her so, and I wrote my own release granting CNA the right to look at anything related to my work and medical care that actually related to my claim, and they had to take it, because they are not in fact entitled to more without a pending lawsuit and a subpoena duces tecum. However, there was no easy sailing after that, and I never did get all the money to which I was entitled. But by then I was worn out and needed to get on with my life. I f*cking have cancer, and I don't have time to waste arguing with morons, and they know this.

What is so very offensive about all this is that my case is hardly the worst they will ever see. I mean, look, three years later, I'm still alive, against all odds. What if I had never worked in law, couldn't read insurance-ese and didn't know my rights? What if, like a significant number of my coworkers covered under the same benefits, English was hardly my first language? And what if it had been a brand new diagnosis of pancreatic cancer?

Why do people have to give up their rights to human decency just to collect services for which they have paid in advance?

The other thing which offended me is how Whole Foods, whose contractors United HealthCare and CNA are (though employees must opt to pay extra for the CNA coverage), did not protect me from UHC's or CNA's probably calculated incompetence, and did not help me, and even while all this was going on -- and I heard while this was going on that lots of other people were having similar problems -- renewed their contract with UHC for another three years because UHC offered the cheapest product on the market. The contract has again been renewed since.

Whole Foods makes a big PR fuss about having all the employees vote for the benefits they most want to have every so often, but the voting is electronic, set up so you can't go back and change your mind, and none of the choices are what people really want and need. And then once it trumpets out a proclamation of what the employees have "chosen," and people try to actually use these benefits, there is no one competent to help them when things go pear-shaped. In my store, when all this began for me, there was one person who was smart enough and interested enough to help me, but she got promoted -- and I even recommended her promotion, even though I knew it was bad for me. Her job, which had been Human Resources Administrator, was renamed company wide around the same time to "Payroll and Benefits Specialist," and the person who replaced her right in the middle of my battle came from the Whole Body department. That's right, shampoo and vitamins. Yup. The only other person in my company who could help me was the regional head of whatever they are calling human resources today, and she was very nice, but she did not have time to make this her battle, and honestly neither did I, nor strength. And this is only part of why I have PTSD around the subject and find it so hard to write about, and this an extreme simplification of why I'm still very, very angry at Whole Foods, so angry I can't even work there anymore, even though I also have a lot of good things to say about it, as large corporations go.

Insurance companies make calculated choices in order to insure their gamble that they will not have to pay out as much as they take in. Employers like Whole Foods gamble that they can offer great benefits on paper for as low a price as possible and not be called upon to actually have to enforce the contracts they make with the benefits providers. The people who lose are the employees. At least at Whole Foods basic health insurance is "free" (if you don't look too closely at deductibles and out-of-pocket maximums and coverage limitations which render the insurance not exactly complete) to every employee who works a minimum of 30 hours a week. So full-time Whole Foods employees pay for their health insurance with labor, not money, though part-time employees who want to enroll have to pay very high premiums. Most companies also require participants in their health insurance plans to help cover the costs out of their paychecks, and as Bonnie's case proves among so very many others, are not guaranteed better service when the time comes to ask for some of those benefits for which they've been paying with their own hard-earned cash. Benefits you "choose" and pay for via deduction from your paycheck: It's the new company store.

The sad fact on top of all this is that universal health coverage in this country probably won't be better. After all, there's the phenomenon of bureaucracy, which might have something to do with the Fed. worker's comp. you mentioned. I think there may even be laws of physics that describe bureaucracy. And all these incompetent staff have to go somewhere, and we are not living in a Douglas Adams novel, so they're going to have to go somewhere here.

But we have to do something. People are suffering and dying because of the system we have, because the system we have is driven by profits, not care. This is proving untenable, except for those collecting the profits.

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