The Failing of Health Insurance and How We are Dealing With That Right Now
Early last week, I joined a three-way call with a lipedema client to try to get her assigned to a case manager through her insurance company. She has a BCBS plan and is working on completing her prior authorization to submit for insurance approval.
A few years ago, I often recommended that women request a case manager through their insurance. Back then, case management services were widely available to members and offered real support in navigating complex processes, such as submitting prior authorizations.
But, things have drastically changed over the past few years.
I’ve noticed a shift; Insurance companies have tightened their services and increased denials across the board. It’s not just liposuction surgery being denied but also orthopedic surgery, insulin for diabetes, life-saving medications, rehabilitation, mental health services, and even cancer treatment…the list goes on and on.
This frustration was highlighted recently by two shocking events: the murder of the United Healthcare CEO and the almost celebratory response from many who have been harmed by health insurance companies. On the same day, BCBS announced a new policy capping anesthesia time for surgeries, only to roll it back after significant social media backlash. It’s clear they intended to quietly push through this harmful policy, and I wouldn’t be surprised if they attempt it again once the outcry subsides.
The landscape of health insurance has changed, and navigating the system is more frustrating than ever. There is no easy way to get through an insurance phone tree to get basic yet accurate information.
This became painfully clear during my client’s call with BCBS. What should have been a simple request to assign her a case manager turned into an hour-long ordeal.
As you may have guessed, we were passed back and forth between departments—customer service to care management, back to customer service—only to be told that she didn’t qualify for a case manager. When pressed for a reason, they couldn’t provide one. Despite claiming to offer case management services, they refused to assign one, arbitrarily deciding it wasn’t necessary.
I knew that was how it would work out, and I’ve never been so frustrated. By the end of the call, we were no closer to a solution, and the system was clearly designed to discourage persistence. This was very apparent during our phone interaction with the man we were talking with. When I told him we were done and he could hang up, he told us to “stay beautiful.”
It shows that they are okay with being unhelpful and condescending.
It’s difficult not to feel conflicted about recent events in the insurance world. While I empathize with those impacted by tragedy, my greater empathy lies with the thousands who have lost their lives, gone bankrupt, or suffered needlessly because of insurance company practices. This pattern of obstruction starts with calls like the one I experienced—endless runarounds with no recourse.
I’ve seen firsthand the devastating consequences of insurance denials. I’ve watched a woman break down in tears because she couldn’t afford the $8/day coinsurance needed for her wound vac (why charge someone eight dollars a day for this? I don’t understand). I’ve watched families scramble to figure out what to do to take care of their elderly mom, who was denied prior authorization for skilled rehab. I’ve seen people hospitalized with complications because they couldn’t afford their medications.
These are not isolated incidents; they’re systemic failures.
During my time working within insurance companies, I witnessed decisions that prioritized cost-cutting over human lives. I witnessed a self-insurance plan remove costly Factor VIII medication from their benefits because one of their employees had hemophilia, leaving him without his life-saving medication. I protested over a plan denying pain relief for an entire group of members because one person in their plan was abusing Fentanyl patches (they are very expensive). Meanwhile, CEOs would approve questionable treatments for themselves that weren’t considered standard care. The inequities were staggering.
I’ve watched so much worse than this, all because insurance uses tactics to deny treatment if the costs are too expensive.
This is why my empathy lies with those fighting to receive the care they need.
Because of the shifting landscape, I decided to stop offering one-on-one assistance with prior authorizations and appeals. The system has become so obstructive that even skilled professionals like me often get nowhere.
A lipedema surgeon recently told me his office spends hours on hold with insurance companies, trying to work through appeals without results. Attempting to work with an insurance company on a single case agreement is met with silence. They can’t get a warm body on the phone to talk to someone to help their patients. His frustration echoes my own.
The direction insurance is heading is unsustainable, and I fear we’ll see even more losses in access to care.
At this point, we urgently need legislation to be passed. That’s why it’s critical to act now. An ICD-10 code is essential, along with legal protections, to ensure we can access the treatment we deserve.
History has shown us what’s possible—like how breast cancer patients fought for and won their rights through advocacy and legislative change. Their journey proves that change can happen when people come together for a common cause.
We can do the same.
I encourage all of us to seek out ways to contribute. Advocacy starts with each of us raising our voices and taking steps, big or small, toward a shared goal. We can push for the recognition, support, and care we all deserve.
Let’s unite to push for the change we need—because everyone deserves access to fair and effective treatment. The first step starts with us.