Mob Rules

by Thomas Greco, Publisher

I’m sure you’ve all heard about the tragic murder of the CEO of a major health insurer in early December. And it truly is a tragedy. No one should be shot in the back and killed in cold blood because of their profession. Of course, like all of you reading this (I hope), I would never condone anything like that. BUT I do understand it. Let me explain.

I’ve written several times about my many experiences with the health care industry. I’ve had phenomenal doctors, and some really bad ones. I’ve been to several really wonderful hospitals, and stayed in some really crappy ones. I have experienced the nicest nurses as well as those who were just flat-out evil. So like many industries, there is always the good with the bad. EXCEPT ONE: the health insurance industry. 

In fact, do you know who the insurance companies are now? They’re the Mafia. And not because the poor guy who got shot was murdered on a New York City sidewalk just like the old Mafia Don Paul Castellano in the ’80s. It’s because they play the same rackets the mob did. They are the only industry endorsed and unregulated (look up the McCarran–Ferguson Act) by the government. 

That’s crazy, you say? Maybe. But isn’t health insurance just another word for “protection”? The mob used to shake down businesses to pay them for “protection,” or else they would let their businesses fade away or blow up and die. We pay for health insurance to cover our doctor visits, hospital stays and prescriptions. They set their rates, and we pay them in order to “protect” ourselves and our businesses from dying. 

Of course, prescriptions are the equivalent of the cocaine and heroin the mob would sell. The pharmaceutical companies are the drug dealers. The doctors are the drug runners. The insurance companies dictate who gets the drugs and how much they will pay for them. If you can’t afford the “vig,” screw you – go away and die. And every year, the “vig” goes up, and the drugs become harder to get. I am telling you, they’re the Mafia. 

Why this rant? Over the last six months, I have spent more time on the phone with my insurance company than I have with my cumare! (Mob joke for levity!) Honestly, every damn month, I get 16 letters from my insurance company telling me how their “expert” has determined that a prescription my doctor has prescribed is not approved. When I call to ask who this “expert” is, how can I speak to him and how it’s possible that he knows what I need better than my own doctor, I get passed on from one operator to another until eventually they either disconnect me or I hang up. I have literally been taking this one medication for two decades, and now they tell me they need more proof that I need it. Are you f$%king kidding me? 

How about this one? I need to lose weight. I feel like shit. I look like shit. Both my general practitioner and my cardiologist think a weight loss drug like Ozempic or Wegovy will not only help me drop pounds, but studies have shown both of these drugs to have heart-healthy benefits. Could a drug be more perfect for me? We submitted the Ozempic first. Denied. We submitted Wegovy. Denied. 

“If you want to dispute this ruling, fill out these 16 forms…” Screw that. I called them. Again, after four different operators, someone asked what the problem was.

“I want to know why I was denied these drugs that were prescribed by TWO of MY doctors.”

“Are you diabetic?”

“No, but I’m pre-diabetic.”

“Sorry, you have to be diabetic.”

“Wait, so I have to get sicker before I can get the drug that prevents me from getting sicker?”

“That’s the policy, sir.”

“Are you fu…..”

Click.

I tried everything possible to get one of these drugs. My doctor offered to do a peer-to-peer call with the insurance company. They said they’d agree to the call only after they got 16 more pages from him. Oh, and he’d have to mark “urgent” on the documentation. Keep in mind that these drugs cost $1,200 per month. No lie. 

I finally gave up. I found a coupon online that got the price down to $600 and bought a month’s worth of Wegovy. My hope is that it works so well, I will not be a complete idiot and realize I feel so much better from the weight loss that I can be disciplined enough to continue on my own. (Don’t laugh! I have done it in the past.)

They are the Mafia. In fact, they are worse than the Mafia. After all, the Mafia may have killed junkies looking to score some heroin, but they never killed little old ladies looking to score some insulin. 

Want more? Check out the January 2025 issue of New Jersey Automotive!