I called our health insurance provider to discover another aspect of deception. The Explanation of Benefits (EOB) was sent out after services were provided and payment settled. The coverage benefits disclosed online are nondescript, vague, and opaque. When I request the contract terms and policy docs that my premiums pay for, I am left with cryptic responses like “we are not allowed to share that”.

A quick search for “can I force my health insurance to honor a single deductible for a single birth” got me to the pre-existing conditions section of healthcare.gov site. To my chagrin, pregnancy is legally considered a “pre-existing condition” which groups it along with other ailments and medical abnormalities. Pregnancy is a gift, not a disease. Where is healthcare going?

Called my employer’s HR department and nobody knew how to even begin to answer my question about prenatal care.

I just spent 6 hours on the phone, my painful afternoon began with an Aetna Customer Service Rep, then a “Health Advocate” ignorant rep, and finally my employer’s PEO. Everyone seems to think the opacity is part of the impenetrable system. And because I have to get back to work, I become another unrecorded data point in the unknown statistic of healthcare injustice.

My wife and I had researched and prepared financially for the coming of a child. The birth center notified us of our total patient responsibility which was higher than I had expected. The receptionist indicated that the prenatal care was considered standard coverage, to which I corrected we had a plan specifically for covering all prenatal costs “100% coverage, deductible waived”.

The customer service rep I reached at our insurance was quick to bullet-list the insurance-defined prenatal care coverage to be 3 things: measuring fetal heart rate, and measuring mother’s weight and blood pressure. Nowhere in the summary nor completed terms of coverage was this identified clearly. Insurance is in the business of selling misinformation.

Here my wife and I were thinking we’d put in the time, research, and savings to prepare for our child to only be sharply blind-sided by the same insurance provider we were entrusting with covering our family’s health? And to switch out of the plan requires proof of other coverage otherwise my employer continues to pay the bill indefinitely!? They took what they liked from ACA and let go the rest. This is what happens when an industry that impacts everyone directly is allowed to grow with little to no regulation.

At least in Europe, the countries have socialized the cost of health so even if there is corruption, it is amortized across the entire country’s population. After experiencing the quality and affordability of healthcare as a foreigner in France uninsured, it was clear that the system works for its people, as a healthcare system should.

From my digging, I’ve surfaced the fact that the insurance industry has adopted the Open Enrollment aspect of the ACA and leveraged it to their advantage, pressuring premium-payers to commit on their insurance provider based on intentionally superficial non-binding and ambiguous summaries of benefits. It’s a rigged game of musical chairs in which you don’t have time to do due diligence on any one chair before being forced to sit on it to discover the truth that it cannot hold your weight.

The institutional behavior is nefarious and depraved, and demands change. The biggest obstacle is the complexity of the existing system of care, suggesting that the only way to improve is to start over outside the system.

What would a new system look like? Decentralized, fragmented, siloed, small practices struggling to stay afloat amidst a surplus of graduating practitioners? Or perhaps we set healthcare provider licensing supply quotas to lag demand to lower supply’s historic pressure on inflating pricing via excessive prescriptions. An idle doc, is a dangerous pathology itself.