It's story time. Let me tell you about insurance companies.

The doctor who headed up our mission teams in the sugar fields of the Dominican Republic, an estimable man, keeps a house in Surrey. That house had a slate roof, and it was failing. Slates were sliding off and sailing through the air, sharp little frisbees of menace. He looked it up in his Aetna policy. His homeowner's covered it. The company sent an adjustor.

"This is covered," the man told him. "On the other hand, each slate is a separate incident, and the cost to repair each one is less than your deductible."

The doctor glared at him. "Get off my property, this instant."

"What?"

"You! Leave! Get off my property right now! I will call the police if you have not gone by the time I get to the 'phone. And your company will pay for this roof. You will have them send someone else, and your company will pay. And then I will terminate my insurance with you.

"Get out! Go!"

The man left, still expostulating, and the doctor did as he said he would do. Not only that, but he has told everyone he knows the story of his slate roof, for the replacement of which the company paid, as its contractual obligations required it to do.

As the doctor said, it was completely obvious that there was a culture of dishonesty at Aetna. "You know perfectly well that if I had swallowed his line about the separate incidents," he told me, "if I had bought it, that man would have been high-fived all around the office for defrauding me. He'd have been a hero. What else can explain that kind of thing?"

Second story

Every time a pregnancy comes to term and results in a live birth, a new human being appears in the light of day. That is not a surprise to anyone. Even insurance adjustors, the lowest of men and women, are not taken by surprise when this happens.

So one of my closest friends read his policy, and noticed no provision for this. He called his insurance company, this time for health insurance, and asked about adding his new son or daughter to the policy. "I want it to cover the three of us, once the baby's born, instead of just the two of us," he said. "When do I need to start the paperwork on that?"

The person on the 'phone said not to worry. "You have six weeks. The new baby will be covered for six weeks. You get the birth certificate and then you can apply for a Social Security number. Once you have the new number, you set the baby up, formally, but the first six weeks are all covered automatically."

"There's nothing about that in the policy," he said.

"No, but that's how it works."

He thought it over, then called again. A second person at the insurance office told him the same story. He took names and dates down, both times. He called a third time, and got told the same. Of course, the bills for care of the child were denied. Denied, because the child was not covered by the policy.

These were utterly foreseeable, almost inevitable expenses, so the company weaseled out of paying them. By lying.

Third story

This one is my own story. I turned forty, then forty-five. My doctor didn't recommend a proctoscopic exam for colon cancer, even though I had always understood that it was routine to have one done at my age. So I scheduled an office visit with my primary physician, asked to get the test, and he referred me to Outpatient Endoscopy Services at the hospital. I went there and had the test.

This resulted in a bill for the office visit at Jack's office, and a bill from Outpatient Endo.

Both were denied.

They said the doc I used was not on their list of doctors whose credentials entitled them to be paid. That was horseshit. He was. I established that he was, and they relented.

Then they denied the endoscopy. It was Workmen's Comp. I needed to work through my employer's Workmen's Compensation insurance. They were not responsible for Workmen's Comp claims.

That was horseshit. It was, in fact, totally random horseshit, horseshit they hadn't thought through in the least. What kind of job injury could ever conceivably result in a referral for a colonoscopy?I was talking on the 'phone.

"Look here, pard. I do have a lawyer, you know," I said, omitting to say you asshole. "I bet I can get this one shoved right back down your throat, and a settlement for fraud besides. I have your name, remember."

"What?"

"I said a punitive damage suit. For fraud. For you, personally. It's a proctoscope. It's a goddamn colonoscopy. Think again. 'Workmen's Comp'??"

The man backed down, but the bill was not paid, and it took a second 'phone call, then a third!

In the meantime, they denied the office visit a second time, saying the code used to make the claim was "not a medical code," and so they didn't have to pay for it.

"It was the code, your code, for an office visit at their office. It has to be the most common code they write. You cover office visits, it says so in the policy."

"We do cover office visits, after the total exceeds the deductible, yes. But the code they used was not a medical code."

He was stubborn, insisting on the point. I had to see the office, since it was up to them to correct this one. The code had been correct all along, of course, because the entire line of malarkey had been shit from the first, but I had to go to Hampden and make the person from Jack's office call them in order to get them to lay off.

This whole process took four months. After three months, delinquent charges would, quite justly, have been added to my bills, if they had gone unpaid that long. So I stopped waiting for CIGNA, and paid the bill in full, out of pocket. The struggle with the sleazebags at CIGNA continued, but eventually they paid. I carried a credit at my doctor's until the next time, and I talked the girl at Endo into refunding me.

And my conclusion?

I submit, as my friend the doctor did, that there is a culture of fraud in the private insurance companies. They have a policy at CIGNA of beginning every adjustment process by denying every claim. You need to file a complaint before they ever consider the actual merits. They didn't say so, but it's so obvious! Workmen's Compensation! For a colonoscopy! Gimme a break!

I submit that insurance companies are the problem. To work for one you have to abjure your conscience and act like an amoral money-driven whelp of Gehenna. They have tens of thousands of employees, who still somehow manage to sleep at night. The lines for admission to hell will be long.

This is the so-called industry we are being asked to protect.