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Consumer Stories


Don Lapin, San Francisco, California
It isn't that Don Lapin doesn't appreciate the refrigerator magnets. They have their uses: holding a recipe to the frig door, or a maybe a cartoon or family photo.

But all things considered, Don would rather that Blue Shield just kept its magnets and other promotional diversions and instead spent its money on keeping his health care costs down.

He figures Blue Shield also could help him and others by cutting back on its false advertising and fraudulent business practices.

Like so many other health care consumers in California, Don has watched his costs go through the roof with increases that seem to come every full moon. It has driven him to the point where he is now choosing not to seek preventive health care. Don wants the government to step in.

Don Lapin is a 46-year-old engineering consultant. Born in St.Louis, he attended MIT, received an M.A. from the University of Houston, and moved to California in 1987.

For the first several years, he was covered through his employer. He went on his own in 1995, with Blue Shield. Since then, it has been all downhill for health coverage and uphill for costs.

Don's deductible has jumped from $1,000 to $1,500; his co-payments are up between 20 and 40 percent; he has a $250 deductible for brand name medicine.

A careful consumer, Don has investigated each proposed increase and found that the information Blue Shield gives out does not jibe with reality. For example, when he looked into going for a $2,000 deductible earlier this year, he checked the Blue Shield web site. It said a man his age would pay $140 a month. When he applied, however, Blue Shield told him that figure was only for 'squeaky clean' applicants, and he would have to pay $175.

By squeaky clean he thinks Blue Shield means he has a pre-existing condition - he had back problems when he had a bicycle accident in Houston in 1983. After learning that Blue Shield considered him unclean medically, Don tried Kaiser. They turned him down altogether because of his pre-existing condition

All information from Blue Shield is accompanied, Don notes, "by a stack of endorsements, full of detailed, confusing clauses changing the terms and conditions of coverage." Blue Shield also tries to distract members from its financial shenanigans by offering "free benefits that I didn't ask for, like toll-free hotlines, health magazines, and web site features." And, of course, refrigerator magnets.

The whole operation is based on diversionary tactics. "They shoot you with a bunch of verbiage" so you won't notice they're picking your pocket.

Don, like other victims of the system, is now hesitant to seek care. For example, he developed a serious cold around Christmas and lost his sense of smell. It still isn't all the way back, but he is balking at taking his doctor's advice to see a radiologist. "It depends on how much it's going to cost," Don says.

Don says the health care system, unregulated, is running wild. "Blue Shield is supposed to be non-profit, but its managers act like they're with Exxon."

Consumers suffer, but it shouldn't be that way. "With the amount of money we have in this country, there should be good health care for everyone."

At a minimum, Don believes health care providers should be forced to present information in a format that is truthful, and that makes it easy for consumers to compare the offer to similar offers by other providers. Web sites should contain honest information, including the truth about coverage of pre-existing conditions and upcoming increases. And insurers should be required to tell how much of consumers' payments go to actual medical services.

"Millions of people don't have coverage," Don notes, and many of those who do are lied to and misled by insurers. They won't police themselves, so until the government provides oversight, the system is little more than "a scam."