Truth in Advertising?

If you've been following the news on TV lately you may have seen this ad for Blue Shield. (For those who can't or don't want to watch the video, here's a summary: A man's face appears in front of the word "happens" on the screen. The man speaks with a lisp and says "I lost my front tooth the other day, which would be great if I was 7. I'm 46. And the tooth fairy doesnt come when you're 46, just lots of referrals, and appointments, and bills that cost tons. Maybe I'll keep it. It adds character, right?" The Blue Shield logo then appears, and a voice-over says "We know life can be unpredictable, we offer affordable health coverage, and also dental plans. Choose Blue Shield today."

The ad reminds us of why insurance exists - to protect against unforeseen harms, like losing a tooth. We are led to believe that having Blue Shield insurance will take care of the hassle and expense of unexpected medical (and dental) problems.

All that makes sense. But is it true? Or is Blue Shield earning its initials here? We'll come back to that in a minute. Meanwhile...

Pop Quiz!

Imagine waking up and finding your shirt soaked in blood. You remove the shirt and find that blood is seeping from your nipple. What do you do?

A) go back to sleep and hope it stops bleeding by itself
B) seek medical care to find out why blood is coming out of your nipple and stop it
C) invite your kinky vampire friend over

Which of those choices would you consider reasonable under the circumstances? Think carefully because the answer might cost you.

Faced with this situation, Rosalinda Miran-Ramirez went to the Emergency Room at a nearby hospital. When it was time to pay the ER bill, her insurer (surprise: Blue Shield) refused to pay for the ER visit, saying that Miran-Ramirez "reasonably should have known that an emergency did not exist."

That kind of thinking puts Miran-Ramirez (and anyone else who has health insurance and might experience an unexpected medical condition) between a rock and a hard place. She can either err on the side of caution (and risk being stuck with a massive ER bill) or else wait (and risk that the problem will get worse because she didn't seek prompt medical attention).

I won't pretend that insurers like Blue Shield are entirely responsible for this situation. Of course, health care costs in general are too high and continue to rise. And the need to make up for unpaid bills is a big reason why emergency care in particular is so expensive. (Basically, people who don't have insurance use emergency services when they need medical care, and when they can't pay the bill, everyone else gets overcharged to balance things out). A public health insurance option would go a long way toward solving this problem, by creating access to scheduled, non-emergency care for those who are currently uninsured.

So perhaps it's a bit unfair to blame Blue Shield, when the problem is systematic. But I can't help thinking that Rosalinda Miran-Ramirez would be calling "BS" if she saw one of those commercials right now.