Here’s how a person without life-threatening injuries (just two fractured bones) gets to lounge in a spacious, expensive, private hospital room for two weeks. To borrow from the “Music Man’s” warning about the game of pool, my saga starts with I and ends with E, spelled I-N-S-U-R-A-N-C-E.

At the start of my recent hospitalization following a bad fall, we called to make sure of my  insurance coverage. We were told convalescent care for therapy following hospitalization and surgery would be “automatically” approved. A few days later, with no explanation, the benefit was denied.

This is a national epidemic. As I spell out my story, I’ll bet you’ll be thinking, “Well, I can top that one.” Any time I tell this tale, the listener (especially people working in health care) inevitably comes up with something even more dramatic. A study by the Kaiser Family Foundation (KFF) determined that, on average, 17 percent of “in-network” insurance claims — some 48.3 million — were denied in 2021. Some companies denied up to half the claims that came their way.

The Washington Post reported one company even has a position with the title “denial nurse.” Some companies use computer algorithms or even AI to “review” and deny benefits without having to look at a patient’s medical chart.

“[M]edicine has become big business. Now health insurance is, too,” editorialized the podcast, The People’s Pharmacy. “These two mighty industries are battling over who can make more money from our illnesses.”

Well, okay. Isn’t that the capitalistic American way? 

But wait a minute. Aren’t we good capitalists taught not to throw money away? To get the most bang for our buck?

After the order for my rehab was denied, we immediately appealed. I’ll spare you the excruciating details of the process other than to make two observations: communicating with an insurance company is as frustrating as trying to reason with a vending machine that’s taken your money and withholds your candy bar. Second, my doctor wasted valuable time on an alleged “peer-to-peer” (doctor-to-doctor) phone call. It turned out he was talking to a mere note-taker who asked a list of generic questions.

I consider myself fortunate. The hospital wasn’t about to discharge me — still too large a fall risk. There I sat, achieving little toward my goal of full recovery that I knew would come with intense therapy. The insurance company ultimately acquiesced. After a week’s delay, I finally made it to the rehab facility. It costs $604 per night. I haven’t seen the hospital bills yet, but on average, KFF says hospital stays in Washington state cost $3,843 daily. Let’s not do the math. It’s too painful.

“The system is broken,” said my doctor, shaking his head. Yet he shows up to work every day. He and more than 20 million other health care workers show up for stress-filled jobs. They tend to patients and side-step obstacles in a system that everyone knows is broken. From CNAs to surgeons, these are the folks who matter. And the bean counters?

They’re out to lunch.