Leigh Williford, WellPoint/Anthem merger — Simi Valley, California

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Most casualties of the health insurance industry’s excesses see their victimhood from one point of view: that of the health insurance consumer. But Leigh Williford has a leg up on them.

Like them, Leigh and her husband have fallen prey to the rising costs that befall other consumers. But she also works in a doctor’s office and sees the "destruction" that insurers are inflicting on those who practice medicine.

Its been aggravating to watch, she says, but anger turned to outrage when she read about the merger between Anthem Inc. and WellPoint Health Networks, the parent company of Blue Cross.

"If Anthem is proposing a $16.4 billion bid for Blue Cross and Leonard Schaeffer is retiring with a $82.3 million plus stock options severance package, after getting $11 million last year in bonuses, then why can’t I get quality medical care?" Leigh asks, not unreasonably, before answering her own question: "Because they are too busy stuffing my money into their own pockets. And I am tired of it."CEO Schaeffer’s profiteering especially agitates her.

"Eleven million in bonuses? Disgusting! Obscene! And here I am having to struggle."

She says it needs to stop. "They are doing it because they can," Leigh says. "Why? Because nobody is saying they can’t. Californians as well as all Americans need to start caring what health insurance companies are getting away with. The ‘I don’t care’ attitude is simply unacceptable.

"Whether you have an HMO, PPO or Medicare," she adds, "you have a voice and you need to start using it."

Leigh has lived in California since 1991. She and her husband Richard married seven years ago, about the same time she went to work as office manager for a vascular surgeon.

Richard works as a distributor, and they are covered through his employer’s health plan.

"My husband and I pay a higher premium for better benefits and still we cannot get the treatment we need," Leigh says. "Why, you ask? Because the insurance company can and does raise the premium. When it does, the employer will not absorb the cost and does not want to pass it on to the employee. The only alternative is to reduce our benefits.

"Now our out-of-pocket costs are much higher, so the employee pays anyway."

Leigh’s premiums did not take the astronomical jump that those of some consumers have, although "they did go up a little bit here and there." The benefits were a different story. "They’ve changed. It’s now $20 co-payment to go to an HMO doctor and $50 co-pay for a PPO doctor, plus 20% co-insurance."

If she goes outside the insurance companies’ network of contracted providers, first there is a $500 deductible to meet, and then a 60-40 co-pay ratio of ‘reasonable and customary charges.’ "Since doctors charge more than is reasonable and customary, I will have to pay the difference," Leigh says.

These changes have caused problems paying the freight for Richard’s thyroid gland biopsy. Leigh says, "it cost us $500 using our HMO. That’s ridiculous." Both Rich and Leigh, who had her thyroid removed after having cancer, need to routinely see an endocrinologist. But in her area there is only one who is authorized by her HMO & PPO health plan. He is a physician she does not trust.

The closest PPO group of specialists is 30 miles away. "Yes," Leigh says, "we could travel the 30 miles. But we would have to miss a day’s work. On a computerized map, ’30 miles’ does not include such things as freeway traffic there and back, city congestion, and doctor time.

"Now not only do I pay more using a PPO doctor, but what about the PPO tests they order, not to mention gas, parking and missing a day’s work?"

"It’s extremely frustrating," Leigh says. "We have a simple life; it’s not extravagant. I’m paying all this money for health insurance, and now I’m paying more.

"It’s just as bad at the doctor’s office, she says. "Professional people get cheated every day by insurance companies. I am on the phone every day fighting with insurance companies for the money my boss has worked hard for and deserves."

"A good doctor is hard to find and they are getting more discouraged every day. Pretty soon a career in medicine will not be sought after. Why? Because the people who run these insurance companies have tactics and ethics like snakes.

Insurers have a treasure chest full of ploys to keep more money for themselves and frustrate doctors and patients, she says. They lose claims. They don’t pay claims. They use tactics like "down-coding," which, broken down to its essence, means the doctor gets paid less, the insurer keeps more.

"They’re just holding on to the policyholder’s money so they can earn more interest," Leigh says.

It frustrates Leigh that Americans "just do not give a damn," and they will not educate themselves so that they can understand the whole picture.

"We are being led to believe there is a health care problem in this country, when in fact this country has excellent health care, with new challenges being met every day."

"The problem is the health insurance companies. It is about us overpaying for the product they sell and getting less than satisfactory benefits in return.

"We are paying huge premiums, co-insurance, co-payments, and out-of-pocket costs while our doctors have to fight to get paid and sometimes lose, or get paid less, while the top executives of these companies are reaping all the benefits of our money.

"I don’t accept that and neither should you," she says. "It’s not right."

Leigh Williford, like a growing number of people in California, is ready to go to war against insurers. "I would love the see health insurance companies stop reaping the benefits of all the money they’re getting from us."

For openers, she would like to see "anything that would make premiums and out-of-pocket costs a little more realistic."

"Regulations need to be made across the board," she adds. She said she would support a regulation that would require insurers to justify rate increases.

"There is so much more wrong with health insurance companies, as well as managed care medical facilities, and Medicare," she adds. "I have only touched on a small part of my issues.""Not only California, but this whole country needs to wake up, stop being victims, and realize we are not getting what we pay for. And then do something about it."

Consumer Watchdog
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