My employer has Health Savings Account insurance. This means that I have a high annual deductible (what I pay before they start to pay) and a savings account that I can add to and that my employer does add to each month with non-taxed dollars to pay for expenses before I've met my deductible.
I have Hepatitis C. I probably received it from a blood transfusion in 1983, before before they knew of Hep C and before they were testing the blood supply for HIV, so I actually feel lucky. I didn't find out about that until around 1996 when I tried to give blood for the first time. I saw a hepatologist when I found out and since the genotype of the virus I have was the resistant kind, I figured a 30% success rate for putting up with a treatment that was almost as bad as Chemotherapy wasn't good enough for me to actually do anything about it at the time.
So fast forward 10 years, to the next time I saw a doctor for this issue. I did see a doctor for an unrelated sickness 8 years before that but that was the last time I saw a doctor at all. I had to fight my insurance company to pay for the doctor's visit but that wasn't very hard and it was my money from the HSA that paid anyway. Their excuse was that it was a "preexisting condition," which I'll give them but legally it's only a preexisting condition if I'd seen a doctor for this in the previous two years. They did pay for those visits but only after angry calls and threats of getting a lawyer. At that visit, my doctor seemed to be steering me towards this same treatment, though the results have gotten better (~50% for the resistant strain) and they know sooner if it's not working and can stop the treatment. Before I got the treatment I started to feel seriously depressed and since suicidal depression is a possible side effect I wanted to make sure it was necessary before I started. So my doctor mentioned that I could get a liver biopsy to see what the effect on my liver had been. I went in, had the biopsy, the results said there was no damage to my liver. Confirmation that the treatment is not an emergency. All told, that brought home a bill of around $2500. I knew this would be an expense so I had put money into my HSA to cover it. My insurance statements, there were 3 of them for this one event, showed up and they covered the doctor's time (1st statement), refused both the lab work (2nd statement) and all the extra hospital expenses like needles and the local anesthetic (3rd statement). What they refused was, again, on the grounds that it was a "preexisting condition." So here I am, 8 mos. later, fighting them to pay these bills that probably won't go above my deductible. This wouldn't feel like such a slap in the face if I was fighting them to cover it with their own money, but it's my money they're refusing to spend. Money I set aside for this purpose.
So this is what I learned, markets are the wrong mechanism for insurance. Markets provide incentives for insurance companies to a) push their responsibility onto the consumer, b) to refuse paying for treatment whenever possible (even, as in my case, the biopsy was cheaper than the treatment likely would have been), and c) refusing or pricing out of the market many "high risk" individuals from coverage altogether. Obviously they also hurt hospitals too because we need to spend much higher percentages of our health care dollars on overhead such as billing departments that don't actually improve health care. And they are paid for this service. A job well done. Too bad that job is creating bankruptcy and making it more difficult for hospitals to provide the care we need.