Navigating the ‘Hoops & Hurdles’ of the for-profit health insurance industry with Barb Kalbach
This is a personal story from CCI member Barb Kalbach, Dexter IA, shared with us as part of the Hoops & Hurdles campaign to call out for-profit health insurers. Share your story and learn more about the campaign here.
When it comes to health insurance, I’m doing alright mainly because I have Medicare Part F. That’s now discontinued probably because it actually covered darn near everything and paid it to boot! But our rural communities aren’t faring very well when it comes to healthcare delivery, in large part because of the hoops and hurdles for-profit health insurance companies make our hospitals and healthcare providers jump through.
Think about the impact of what insurance companies and their billing practices are doing to our rural hospitals. Submit billing for the treatment of a patient and it’ll be denied, then you re-submit again and again until it’s finally approved and that could take a year before you get payment. Either you hire an additional staff-person who only submits billing over and over and over, or you’re taking away time from doctors and their patients because they’re on the phone with the insurance company.
And how about everyone’s ‘favorite’ - prior authorization? You and your doctor decide what you need, but you need prior authorization from a health insurance executive sitting somewhere hundreds or thousands of miles away who knows nothing about your situation. They talk about how this is to control healthcare costs, but it’s not – it’s all just about lining their pockets with our money. Insurance companies aren’t concerned about the patient’s health; they’re concerned about the cost of the procedure. In rural Iowa, this problem went from bad to worse when Branstad and Reynolds privatized our state’s Medicaid program and handed it over to out-of-state for-profit Managed Care Organizations.
There’s critical access hospitals closing in droves across Iowa and the heartland, and why do you think that’s happening? It’s in part due to the for-profit health insurance industry that delays and denies care and payments to our critical hospitals. With no hospitals there’ll be no manufacturing jobs, no people moving to our communities and rural America will continue to suffer and stagnate at the hands of big corporations and the wealthy elite. At best, maybe we get a glorified emergency room which is better than nothing, but it’s not what our communities need to survive, let alone thrive.
It’s like a shell game. And it’s by design to just make a handful of rich people richer, at our expense. And don’t even get me started on Pharmacy Benefit Managers, one of the biggest cons of them all. Not only are our rural communities losing hospitals and urgent care clinics, we’re losing our local pharmacies with these PBMs who make money hand over fist – and they don’t really do anything or serve a purpose! If we truly want strong and vibrant communities, especially in our heartland, the hoops and hurdles created by health insurance companies and Big Pharma have got to stop.