“That’s Covered By Our Insurance?” “Correct.”


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.

FACT:

Mother Jones was founded as a nonprofit in 1976 because we knew corporations and the wealthy wouldn't fund the type of hard-hitting journalism we set out to do.

Today, reader support makes up about two-thirds of our budget, allows us to dig deep on stories that matter, and lets us keep our reporting free for everyone. If you value what you get from Mother Jones, please join us with a tax-deductible donation today so we can keep on doing the type of journalism 2019 demands.

We Recommend

Latest

Sign up for our newsletters

Subscribe and we'll send Mother Jones straight to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.

Subscribe

Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.

Donate