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

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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.

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DEMOCRACY DOES NOT EXIST...

without free and fair elections, a vigorous free press, and engaged citizens to reclaim power from those who abuse it.

In this election year unlike any other—against a backdrop of a pandemic, an economic crisis, racial reckoning, and so much daily crazy—Mother Jones' journalism is driven by one simple question: Will America move closer to, or further from, justice and equity in the years to come?

If you're able to, please join us in this mission with a donation today. Our reporting right now is focused on voting rights and election security, corruption, disinformation, racial and gender equity, and the climate crisis. We can’t do it without the support of readers like you, and we need to give it everything we've got between now and November. Thank you.

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