What I don't understand about insurance (rant)

[KaiserKid 81]

OK, so this has less to do with my own insurance issues, but is more a philosophical/social rant. Partly because I'm deathly afraid of getting denied by own insurance as I'm just starting out my journey. I'm super fortunate because my plan covers VSG. I know the requirements, and I meet them (for now), but I'm afraid of getting pulled a fast one and getting denied anyway. I digress...

So, I've done a lot of research on this. If I were to pay out of pocket for a VSG, it will run me about $14k - $20k. I have health insurance through my employer and pay about $8k per year just for myself. I've had said insurance for about five years, only requiring an annual doctors' visit which runs about $1,200 (I've previously been accidentally sent the bill, so I'm basing it off this). I have no medications other than oral contraceptives, which are free (Thanks Obama, no pun intended).

In doing the math, over the course of 5 years, I've paid up to the order of around $40k to my insurance company, which in theory could pay for two of these surgeries out of pocket.

I've heard plenty of stories of people whose plans do cover the procedure, but are denied through some loophole the insurance company finds. I don't know all the nitty gritty details about how health insurance works in the US, but something seems fundamentally wrong if people are paying so much for a "service" (I know that's not what it is, but I guess we'll call it that for the sake of simplification) and are denied a request to use said service if the cost is less than what the individual has paid for over the years. Then again, I'm sure the $8k I pay annually "for me" isn't really "for me". Perhaps some of you can enlighten me on the topic?

And in my case, I'm just saying I'll be really mad if the rug gets pulled from under my feet by my insurance company after I think I've done all my homework. I've hardly needed them in the past, thankfully. It'll just be disappointing if the ONE time I do need them, they tell me to screw. I guess it's called insurance for a reason.

No need to comment or anything, as there really wasn't a question here. I just had to get it out and Twitter only allows 140 characters. End rant.

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If you qualify and the request gets sent properly, you'll be fine.

Sent from my iPhone using the BariatricPal App

[Bufflehead 6,358]

You hit the nail on the head -- the money you pay for your insurance isn't for you. It's not a medical savings account. The money you pay is for your co-worker's preemie infant who spent 60 days in NICU and ran up a bill of hundreds of thousands of dollars, or your boss who had cancer and underwent months of chemo and radiation and surgery. Surely they shouldn't be denied because they hadn't paid hundreds of thousands of dollars in premiums, right? And you recognized that insurance makes sense for you, as you chose to invest your money in insurance premiums rather than in a savings account. If you get the surgery then get hit by a bus two months later, the insurance company isn't going to refuse to pay your hospital and rehab bills on the grounds that you already "spent" your premiums on bariatric surgery.

Personally, I would get rid of insurance companies, profit motives, and the idea that the best way to measure health care outcomes is whether the practices save money, rather than whether they save lives and improve health. I don't think any of this makes any sense as a way to provide health care -- and we aren't doing such a great job given our pathetic rankings in worldwide health outcomes when compared to other developed countries.

I do think you'll be fine and get approved. You know the requirements and know what you need to do to meet them, and you seem like an intelligent, articulate person who will stand up for herself if insurance does try to pull a fast one. Good luck!