Personal Finance

Meet My Upper Middle Class Family, We're Drowning in Health Care Debt

| by Russell Fine

I’m a member of the “upper middle class” in this country and I can’t make my ends meet.  This month alone, my family will have a deficit of over $2,000.  And its almost all health care related.

My wife and I are college educated and have both built and run small businesses.  My businesses include Opposing Views and a small marketing company.  My wife is the CEO of a non-profit which serves 10,000 needy people.  She makes a modest salary and her organization provides us with “best-of-class” health care benefits, a PPO plan, which supposedly allows us to use any physician so long as we pay part of the bill.   

Here’s how our best-of-class plan treats us:

Our children’s school had an outbreak of head lice.  It happened before summer, and we didn’t know until the end of summer, so it was severe.  The cost of professional de-lousers and related products exceeded $2,000 for a family of four (mostly for the two kids).  Health claim denied for “lack of a diagnostic code” (which, by the way, was clearly typed on the form).

8 months ago, my teenage daughter began suddenly losing weight.  Our primary care physician immediately sent us to a pediatric gastro-enterologist to test for physical problems, accompanied by a therapist.  The bills for the gastroenterologist were paid, half of the tests weren’t.  None of the therapy was paid for.  Why were they denied? The insurer claimed they didn’t have enough information from the lab or providers (who had sent the paperwork in).   And, yes, we contacted the providers who re-submitted the information – no change.  Over $3,000 in medical claims denied.

We have another family member that has a continuing illness, requiring medication and therapy.  Therapy declined outright (again – because there is “not enough information”).  There’s another $750 per month.  

To be fair, if we take a “normal” trip to the doctor or to an emergency room, it is usually covered within the bounds of the policy (for which I pay more than my fair share).  But it seems that every month there are  “unusual” charges that don’t get covered due to the insurer’s intentionally difficult claims process.

The health care industry has fundamental problems.  It is one of the few industries in which the payer and the recipient of the services aren’t the same.  A physician’s “customer” is the insurer because they pay the bills.  Insurers, their customer, are financially motivated to provide the least and worst care possible.  One thing I’ve learned about business is that motivation is everything, and this system doesn’t motivate these companies to provide good health care.

Our household income, according to most forms we fill out, is in the upper bracket, and yet we can’t make ends meet.  We attend public schools, drive a Ford, and live a relatively modest life.  What’s the problem here?

I know that all of you need to be elected, and that your family’s well-being depends on it.  And I know that being re-elected is about party affiliations, public relations and making a splash in the press.  But, while you are wrestling with your political opponents, you are letting your constituents down.

Stop arguing and find a plan.  If it doesn’t work, try another one.  We can’t wait too much longer.