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Exploring the Intersection of Insurance and Health Equity
Edited by La’Quitia Denson
On episode two of the 52 Weeks of Health Equity podcast, we had the privilege of chatting with Daniel Greenbaum, an attorney based in Los Angeles. Daniel specializes in personal injury law, with a particular focus on motor vehicle accidents. However, in recent years, he has also delved into the realm of bad faith insurance claims and become interested in the impact of insurance on the overall quality of life we live. We discuss his experience with personal injury law, insurance and health equity. The following is a shortened and blogitized summary of that podcast interview.
Daniel Greenbaum
I am an attorney in Los Angeles, and I focus on personal injury in my practice, which includes a lot of motor vehicle accidents. However, in the last few years, I have also started to concentrate on bad faith insurance claims. The reason I have become interested in this health equity component is after handling and speaking to dozens, and maybe even more, of these types of cases and filing lawsuits on behalf of people against their own insurance companies.
Tahitia
The CDC defines health equity as ensuring that everyone has a fair and just opportunity to achieve optimal health. It emphasizes reducing barriers, as suggested by the Robert Wood Johnson Foundation. These barriers include poverty, discrimination, and their consequences, such as powerlessness, racial inequity, and limited access to good jobs, housing, and quality education. These factors are known as social determinants of health. You mentioned bad faith insurance cases. Could you please explain what that means?
Daniel
I have a current case example for you, it's not health insurance though. Here's what happened: someone returned to their car after a long day and found it vandalized. Later, while driving, the car's engine broke down. The person filed a claim, and the insurance company agreed to cover the body damage but refused to pay for the engine breakdown. They claim it's a coincidence.
Tahitia
I understand this isn't a health insurance case, but basically, the client had car insurance because it's what we're told we should have, to ensure it covers all potential incidents. But it sounds like when they went to utilize it, they were met with some resistance.
Daniel
Yes, with all insurance, that's the problem. I don't want to delve too deep, but the insurance industry underwent significant changes; there was a major shift in the late nineties, maybe not even thirty years ago, moving into the early 2000s. Companies began asking, "How can we maximize profits?" I understand that companies exist to make money, given the current workings of capitalism. They realized that the only way to increase profits was by controlling claims, which they couldn't previously do. They could try to sell more insurance, but ultimately, their market share would be determined by external factors.
That's when they discovered that they could focus on the claim center. It started with Allstate and then spread to others. It's public knowledge that they hired an efficiency expert, McKinsey, to help them. Thirty years ago, the adjusters' job was to come in, assess the claim, and determine coverage. They would say, "Okay, you had fill in the blank happen and it's covered. We'll cover forty percent of the cost, which is $100,000. We cover it straightforwardly." That's how it worked, based on the experiences of experts I've talked to, most of whom were in the field thirty or forty years ago.
Daniel
We've come far away from an insurance company saying, "I owe you the money, and I'm going to pay it because you paid in." It's the one thing we do where you pay ahead of time. You pay and you pay, and then you don't get the benefit until much later. They get to decide if they're going to give you the benefit of the contract that you paid for. They have all the cards. So what we get is claim centers turned into profit centers for insurance companies. They know that you can go through the appeal process, but many people don't because of the time or the expense. That's part of, I think, what you talked about: access and equity and all the things that the CDC (Centers for Disease Control and Prevention) and the equity guidelines talk about. Insurance then becomes a barrier to access, it gets in the way of us achieving that, and they're penalizing us for it.
Tahitia
For those who lack knowledge or time to navigate such matters, this can also contribute to mistrust in the healthcare system and what doctors say. It undermines our belief in doctors' understanding of insurance and the rationale behind ordering tests. It's like setting doctors up for failure. For people with limited income, this can lead to a snowball effect of debt. Why create such a system?
Daniel
In my experience, both parties are at fault. Bad faith occurs when you've been wronged by your insurance company, such as having a claim denied. This is particularly evident in personal injury cases involving third-party claims. It's not directly related to health, but it affects everything because experts have noted similar issues in their work as car adjusters.
For instance, when you're involved in a car accident, and the other person claims injury, the insurance adjuster questions the validity of your medical bills. They may dispute the number of chiropractic visits or the necessity of certain treatments, like injections or surgeries. In such cases, you have to search for affordable options because you're unsure if the at-fault driver's insurance will cover the costs. It becomes a constant battle to justify medical expenses and negotiate fair settlements.
Tahitia
Why pay for insurance if they're going to fight so hard when you use it. Is a common sentiment among many who don't trust the insurance industry in the United States. Even when the ACA (Affordable Care Act) was introduced, people questioned the value of paying for something they might not use or that wouldn't fully cover their needs. This creates a sense of bad faith, eroding trust between customers and insurance providers. As a result, many individuals prefer to take their chances and pay out of pocket when needed, rather than relying on insurance.
Daniel
Right, don't make a claim unless it's a significant amount. Our house insurance broker advised us not to. One of the windows shattered, possibly due to extreme heat. I was shocked when he said not to make a claim unless it's thirty or forty thousand dollars. The impact of insurance, whether it be health insurance or other types of insurance on our well-being is crucial, because it is supposed to cover uncertainties.
California recently updated its minimum coverage, facing opposition from the auto insurance industry. Medical malpractice insurance hasn't been updated in fifty or sixty years. Previously, a $5,000 limit sufficed for property damage, but now a minimum of $25,000 is required. Now, for the bodily injury, one night in a hospital might be $10,000 or $15,000, depending on what they do. Now add an ER visit with the ambulance, doctor, and other services, and you get lots of different bills. All of a sudden, you have one hospital visit, and you get five different bills. The cost can be overwhelming.
Tahitia
Things have gotten more expensive. In addition, what healthcare organizations charge insurance companies, is less than what they actually paid after negotiated fees. Maybe they paid a quarter of the bill, yet most individuals don't have that option. Because if health insurance companies are paying a percentage of what you might pay, that's less back to hospitals, who look to make that loss up in other ways. If you're paying out of pocket, there's always that little caveat from the hospital or whoever is billing you; they'll work with you. Maybe not to the same extent as they do with the insurance companies, where they have some negotiated rates, but something.
It's this system with all these little nuances that the average person doesn't know about. So, who it harms, it sounds like, and who it prevents from having access to healthcare and saving money is the individual, even those with insurance. Because part of getting any type of insurance is to ensure that you're not going into financial debt if something should happen, yet it seems like today everyone is getting a bill.
Daniel
Absolutely. So for example, comedian and talk show host, John Oliver, purchased a significant amount of medical debt for a fraction of its value and subsequently eradicated it. This act underscores the absurdity of the current system. That you can buy medical debt for a fraction of the stated cost and then make a profit collecting that debt. Another illustration is the TV show Breaking Bad, which humorously and yet profoundly depicts the extent people go to in order to afford cancer treatment, reflecting the realities of our healthcare system.
Based on my experiences working in personal injury cases, researching healthcare history, and considering the positive outcomes in countries like Finland and England, I am wholeheartedly in favor of universal healthcare. It not only leads to greater overall happiness but also eliminates worries about job loss, pursuing education, taking sabbaticals, or starting a business. While my wife and I, as educated middle-class individuals, can manage the exorbitant insurance premiums, it is unjust that most people cannot. The adverse effects of inadequate healthcare disproportionately impact the working class and communities of color, intensifying the challenges faced by those in poverty. Universal healthcare is a logical and morally sound solution, given the evident benefits it offers. The opposition to it remains puzzling to me.
Tahitia It's surprising how, in our country, we fail to support community initiatives despite claiming to care about children, access to resources, and the working population. In some cases, engaging in crime becomes more profitable than working, as depicted in "Breaking Bad." This raises concerns about our societal direction in the US.
Conversations with people from other countries reveal their priorities, such as holistic healthcare and psychological safety. Ironically, in the self-proclaimed number-one country, our aspirations are often as basic as accessing life-saving surgeries without financial strain. In the United States, we simply want to be our healthiest selves, yet this is sometimes seen as asking too much.
Daniel I recently watched an intriguing discussion or debate between Venchapero and a commentator from The Young Turks. They delved into the topic of healthcare, and it was fascinating to observe the points of agreement they reached. One notable distinction made by the commentator, which Venchapero had to acknowledge, was that the United States indeed boasts the best medical expertise and technologies in the world. As someone of Jewish background, I personally appreciate the advancements originating from Israel. Nevertheless, the US remains at the forefront of groundbreaking scientific discoveries. Take, for instance, the remarkable speed at which COVID-19 vaccines were developed, even though the initial breakthrough occurred elsewhere. The funding and resources enabled us to achieve such extraordinary progress, which is truly awe-inspiring.
However, the discussion also shed light on the issue of equity, which is the crux of the matter. Despite having world-class medical capabilities, the cost of healthcare in the US renders it unaffordable for many individuals. People are resorting to health vacations in countries like Mexico, Bali, and other places to receive necessary treatments. I recall hearing an interview or reading an article about individuals from Perth, Australia (if I'm not mistaken, it's on the west coast), who fly to different locations, including Bali, for affordable dental work. They can get top-notch care, return home, and still spend less than they would by staying in Australia due to the cost difference. While many countries are performing better than the US in this regard, even Australia exemplifies the point that people are increasingly traveling abroad to seek affordable treatment.
Tahitia
So back to that one person fighting against a giant insurance company. They know they can wait you out and keep throwing obstacles at you. I think about my son, who was injured at school, and they paid for everything. The paperwork was overwhelming, and determining responsibility for payment was a battle. I had the privilege of having access to resources like fax machines, but many don't. We unknowingly create barriers for people to get what they're entitled to with insurance. People often give up and let it go to collections.
Daniel
Of course, well, that's why we have so much medical debt in this country. It makes up a giant percentage of the collection industry. It's sad. The insurance companies are supposed to work for you. You paid in, but sometimes they fail to honor the contract. Let me give you an example. I knew a woman who wanted a vaccine. She made an appointment with the pharmacy but forgot to get prior authorization. Her insurance covers it, but she still had to get pre-approval,but it was not covered because she missed that step. She lived far away from the pharmacy, so she just gets it because of the time already involved. She ended up paying the $140 out of pocket. The insurance company knows she won't fight it, but she shouldn't have to. This is why I support universal healthcare. Insurance companies list covered items but often refuse to pay when you need them if you miss a step. Mental health coverage is even worse. We have laws, but they don't adequately cover it.
Tahitia
Mental health historically has been barely covered. I remember years ago it was something odd, like five visits a year for mental health issues. So, I wonder if many of us are still stuck with the same mindset as the insurance companies, thinking that something only costs five dollars when it actually costs five thousand, or that certain problems can be quickly fixed. Are we still holding onto these false beliefs or has that changed? I know you mentioned earlier some states are addressing the issue of rising costs and forcing insurance companies to change their reimbursement rates or limits.
Daniel
Yeah, when there are laws in place, but the problem is, the insurance companies make it impossible for those affected to take advantage. The government has done nothing, and I haven't been able to find a way for a private person like me to represent them and file a lawsuit without taking on additional costs. I haven't found that mechanism yet. I would love to talk and connect with other people in this area.
I think everyone needs to know that insurance works for you. That's the main takeaway. They make it difficult and delay everything. It takes months for them to respond or put you on hold for an hour before speaking to someone, and it's a different person each time. These are their tactics. They change the adjusters frequently, so you have to explain your situation repeatedly. They deny claims repeatedly. An example of a serious case my partner had was a coverage denial for implants after a double mastectomy, even though the law requires it. They simply refused. In that instance, the cost of implants and the mastectomy could be around $100,000, which makes it worth going to trial, and considering attorney fees.
Tahitia
That's expensive. Is it worth it for an attorney on average in terms of smaller cases for a lawyer to take them on?
Daniel
That's the problem. I wish I had a non-profit firm to address this issue. Maybe forming a non-profit center could help. Currently, there's an example of a woman who didn't receive her HPV shot and was overcharged. Filing a lawsuit in California over a $130 discrepancy doesn't seem practical. Small claims court could be an option, but it involves fees, serving, and potential time off work. Is it worth it? Maybe not.
Tahitia
So, they're (insurance) really rolling the dice, hoping you'll quickly realize it's not worth it. Those who can afford it will pay, while others accumulate growing debt with greater impact. Unpaid debt affects credit, creating a cycle where renting a good apartment or buying a home becomes difficult. These factors impact our current and future health. The lack of a safe place to live tomorrow becomes a health incident. This is how capitalism oppresses everyone, not just marginalized groups. Imagine the benefits of making the simple act of health and existing less challenging.
So Daniel, how can they reach you or get in touch with you if they want to work with you?
Daniel
I'm located in Los Angeles. You can visit greenbaumlawfirm.com for my contact information. I'm happy to talk to anyone facing these issues, even if they're in a different state. It's important to fight back and seek support for healthcare challenges. My grandmother always said that without good health, we have nothing. Let's value our well-being and stand up against insurance injustices. Make your claim, appeal it, and find a lawyer if needed. Together, we can seek justice and make a difference.
Tahitia
They're wearing us down, but we can wear them down to do the right thing. We're currently in a health crisis, be it mental or physical health, and we need to prioritize and find a way to proceed. Thank you, Daniel, for being on the podcast. This conversation is invaluable, as legal and health are closely linked, especially in the U.S.
Greenbaum Law Firm
The Greenbaum Law Firm, established in 2014, strives for just results by fighting large injustices and assisting individual clients in receiving the personal justice they deserve through public interest litigation and representation in personal injury, civil litigation, and debt collection matters.
Bad Faith Insurance Claims
What is Bad Faith Insurance Claims and Greenbaum can help.
Healthcare Costs Around the World
World Population Review provides country rankings on health care costs, offering valuable insights and comparisons on the expenses associated with healthcare across different nations. It serves as a comprehensive resource for understanding the varying financial aspects of healthcare systems worldwide.
Ambulance Cost By State
The CBS News article discusses the issue of surprise medical bills and balance billing, highlighting the efforts of some states to protect patients from these unexpected charges and advocating for federal legislation to address the problem on a broader scale.
John Oliver and Medical Debt Forgiveness
(Read more about John Oliver's purchase of medical debt)
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