Bike Ride Part V - Subrogation & Spite

To the typical rebuttal to the frugal way of life, and working toward our FI plans:

But, what if you get hit by a bus?

Well… I did, only it was a car.  This is Part 5.  You can catch up on Part 1, Part 2,  Part 3 & Part 4.

Recap

So, I'm sure you're just as shocked as I am that there is a part 5 to this series.  Yes, it's now 18 months after my accident, I was told the whole thing was done over 6 months ago.  But, as we all know,  anything that has to do with healthcare in the US is an unmitigated disaster.  So, here we are.  A whole new episode, and this one is brought to you by the letter 'S'.

S is for Shakedown

There's a term the mafia uses: Shakedown.  It basically means that the mafia forces you to pay for  their "services".

It works like this:

Mafia Man - "You owe us $980 a month."
Mr Wow - " For what?"
MM - "Protection"
MW - "From What?"
MM - "Bad Things."
MW - "Hmm... Ok I guess.... if you're gonna protect me from bad things."
****  Bad Things Happen to Mr Wow ****
MW - "Hey, Mafia Man, bad things happened. Can you protect me?"
MM - "Yeah, we don't protect from those bad things."
MW - "WTF??  What's the money for??"
MM - "Protection from bad things."

Now, I'm not involved with loan sharks and shell dry-cleaning companies, no.  In my case, you can replace the Mafia Man with United Healthcare and it's the same exact damn thing.

Let's recap:

1. They charged us $980 a month for premiums on a $5,000 deductible per person for a PPO.


2. When we were uninsured, Mrs Wow went into get her prescription, the pharmacist told her the cash price would be $9.99.  What? The co-pay is $30???  How is it cheaper to NOT have insurance?


3. We were traveling to South East Asia to do medical volunteer work.  Like any responsible adult, we went into our doctor to get any recommended vaccines.  Low and behold, United Healthcare wouldn't cover the vaccines.  You know why?  "It's a luxury to go on your trip, you don't have to go, so we don't have to cover it."  So wait, a vaccine to a curable disease is a luxury?!?!  WTF?


4. I get run over by a car.  I deal with all the pain and suffering.  I follow up with all the paperwork, and close the claims.  United Healthcare is no where to be seen until 6 months after I close the file, with a threatening letter about me reimbursing their expenses.  Huh?

For some reason I feel like their company values are all complete bullshit:

Compassion

Walk in the shoes of people we serve and those with whom we work.

Who in their right mind would walk in these shoes?

The company had it's largest quarter ever in Q4 2017: UnitedHealth, the largest U.S. health insurer, reports profit that more than doubled from a year earlier.   At least I know where my premiums are going since they aren't covering vaccines for curable diseases or covering their insured in accidents or lowering the cost of prescriptions.  You know, the things health insurance companies are... um...  supposed to do.

So, yeah, UNITED HEALTHCARE = MAFIA!  Which leads me to our next 'S' word:

S is for Subrogation

Subrogation, that's a mighty big word.

Subrogation is a legal doctrine whereby one person is entitled to enforce the subsisting or revived rights of another for one's own benefit.

What does that mean in English?  It means that an insurance company has the right to get reimbursed for the expenses it paid out.

So, what does this have to do with me, it wasn't my fault I got run over by a car?

Well, I was traveling with Mrs Wow and when we returned home, I had a nice letter from my insurance company threatening me that I had to repay them the expenses they incurred from the accident I was in.

So let's recap all what has happened here:

1. I'm paying my insurance premiums to the tune of $980 a month.


2. I am riding my bike home from work and get t-boned by a driver that wasn't paying attention.


3. I end up in the emergency room, where they take all my wrong information.


4. My insurance company only pays 20% of the expenses, because the ambulance took a concussed motor vehicle victim to an "out of network" hospital.


5. My insurance company tells me that I am only responsible to get the out of pocket expenses for reimbursement from the driver's insurance.


6. I have to pay my medical claims because my insurance company is dragging their feet so much that the hospital is threatening to put it into collections.


7. I negotiate a settlement with the at fault driver's insurance company to reimburse me for my expenses and my time.


8. My insurance company wants their expenses covered out of the settlement that I negotiated with the at fault driver.

Can someone explain to me exactly how this works?  I pay premiums to my insurance company, then when I get in an accident that is no fault of my own, they force me to reimburse their expenses???  I understand they have Subrogation rights, but shouldn't that be the at fault driver's problem?  Not their own paying customer????

Now, before you think just I got screwed, we're all screwed.  Yup, it's in every one of your insurance policy statements, down there in the fine print.  "We have the right to sue you for reimbursement of our expenses."  And because we aren't allowed to negotiate the policy contract, since it's provided by the employer, we're all stuck with it. Think I'm kidding? It's right there on page 60 of the thrilling page-turner that is your 200 page plan doc.

Go ahead and Click... It's Fantastic!!!

Pleasant huh?  Apparently, this is a thing, as I've been talking to a journalist about a story he's doing on this very practice.  Which leads me to our next 'S' Word:

S is for Systemic Failure

I've gotten into this a little before.  But I wanted to bring it up again.

I don't understand how medical insurance makes sense as a for profit enterprise.  If we are forcing everyone to pay into the system, then the system better damn well cover me when I need it.  I shouldn't have to fight to worry about how we are going to afford getting run over by a car when it's not even my fault?

This is an appropriate quote:

Americans live one sickness or accident from bankruptcy. - President Obama

There is clearly something wrong here, and no one wants to try and fix it:

A recent Harvard University study showed that medical expenses account for approximately 62 percent of personal bankruptcies in the US. Interestingly, the study also showed that 72 percent of those who filed for bankruptcy due to medical expenses had some type of health insurance, thus debunking the myth that only the uninsured face financial catastrophes due to medical-related expenses.

After what I'm going through, I'm not really shocked.  Can you imagine?  What if I was incapacitated?  What if I wasn't able to provide for myself anymore, and my lovely wife would not only have to take care of her husband, but also deal with this and attempt to work to pay off all the medical debt?

During the year that this happened, we shelled out over $19,000 in medical expenses, most of which is a premium to a company who is doubling their profits every year and paying their CEO $66 million in 2014.  Which in turn refused to cover basic medical care when needed, and then came after their paying customers to reimburse the company's expenses.  Remind me again why I'm paying them?

There's a great post over on Investing Doc, that discusses how doctors can't get taken out to lunch by reps, yet congressmen are taking 6 figure bribes to keep the insurance and pharmacy companies raking in the dough.

Then, sadly, there's this gem:

I was told by my insurer that my husband's final transfer to the hospital in the nearest big city was not medically necessary. He DIED. They tried to reject the end-of-life medical claim as "not medically necessary.".

Health care as business sucks.

— Emily Isaacson (@Emily_Isaacson) March 9, 2018

Single payer healthcare might not be perfect, but it seems to work in every other developed country in the world.  Plus, I hope they could figure something out with $19,000 from two healthy people, because it's now becoming a thing to simply roll the dice without insurance.

Systemic failure indeed.  Which leads us to our next 'S' word:

S is for Spite

Spite: a desire to hurt, annoy, or offend someone.

It's a very interesting word that I don't tend to use often.  In fact, my favorite use of the word is: Spite House.  For those of you that don't know what a spite house is, according to wikipedia: "A spite house is a building constructed or substantially modified to irritate neighbors."   And they're fantastic!  It's all about people who hate their neighbors, the government or developers and build a house, or refuse to sell, just to be a pain in the ass.  I think the most popular one in recent history was chronicled in the movie "UP".

So why bring this up?

Well... out of spite, we are now proud owners of a new stock with the ticker UNH.  Not enough to impact anything, but I figure, I might as well have my grubby hands out just like the rest of them.  They pay dividends, which I'm sure come from all the unpaid claims and rebates from providers that they don't pass along:

Another lovely section of the plan document (I read too much of it)

So hopefully at some point I'll get some of my money back from those MF'ers, although I'd never be happier to see a company in which I own stock go Chapter 7.  Which leads us to our final 'S' word:

S is for Share Holder Meeting

I can't wait to see if I get an invite to that!!! Ha!  Mr. David Wichmann is gonna have some 'splainin to do.

Yup, we own a little slice of my mortal enemy!

*BONUS* S is for Shithead

So, I guess we're going to end up with an Episode 6.  I can't believe it, this is turning into Star Wars!!!  Right now I'm going back and forth with their subrogation arm, Optum.  It's interesting to say the least, as I put up a fight against their collections agents.  I'm definitely breaking one of our cardinal rules :

"Don't be a shithead."

For the time being, just call me Shithead: