Here’s an excerpt of a recorded telephone conversation between David Cienfuegos’s wife and a rep from Anthem Blue Cross (“Howard”) prior to a surgery that Cienfuegos underwent:
Wife: So how can I find out if the doctor we’re working with is contracting with Anthem?
Howard: If you know the doctor’s name, I can look them up for you.
Wife: The doctor who is doing the procedure … is Dr. Werthman, W-e-r-t-h-m-a-n.
Howard: Philip?… Yes, that doctor is in-network.
Wife: Oh, OK. So when I submit my claim form, that goes towards the in-network deductible?
Howard: Correct…. That is correct.
Wife: I just wanted to then confirm that the procedure, veri — I’m sorry, what was it called again? I know I gave you the name.
Howard: Uh, varicocele. I am not quite sure how you pronounce it.
Wife: Varicocele. That’s covered by our insurance?
Howard: Correct.
You’ve probably guessed the punchline already: After the surgery, Anthem denied Cienfuegos’s claim, saying his doctor was out of network and the procedure wasn’t covered. This is the kind of innovation and cost-cutting efficiency that makes it so important to keep private insurers at the core of our health care system.
