When Health Cover Isn’t Really Cover At All

A rant about semantics, legal mumbo, and cocktail umbrellas.

I had surgery recently.

(I’m OK.)

But in the lead-up, I called my private health insurer to check if my surgeon’s fees would be covered. “Yes,” the kind woman on the other side said, “you’re covered for that.”

Fast forward a couple months and it turns out I was, like… 5% covered.

Which… isn’t really covered at all.

In fact, I don’t think ‘covered’ is the right word for insurers to use here.

Let me put this in another context.

Say you and your mate are ordering at the bar, and you go to pay for your schnitty and beer and your mate says “Don’t worry mate, I’ll cover you.”

You’d think, “Damn, what a good mate. I’m so lucky we’re mates, mate. Let’s be mates forever.”

Now imagine that, as you’re leaving the pub, your mate says “By the way you still need to pay the bartender.”

“What?” you say, “Didn’t you say you’d cover me?”

“Yeah.”

“So why do I have to pay the bartender?”

“Well, I covered you $3. You still have to pay $22.”

That’s not really ‘covering’ someone — you feel me?

And if your health cover is covering you like that, I don’t think they should be allowed to use the word, ‘cover’.

Maybe they could say ‘half-covering’, or ‘partially-covering’, or ‘5%-covering’ — but definitely not ‘covering covering covering, I’m covering you with your health cover so much, you covered little cover. You’re so covered I can’t even see you, where’d you go!? There you are! Buried under all my coverage.’

I also don’t think you get the right to plaster little umbrella icons all throughout your iPhone app. Unless of course those umbrellas are 1:1 actual size, which would then be a fairly accurate representation of the coverage you provide.

But even then, if I’m out in the pouring rain, and you’re there with one of those little paper umbrellas you find on the rim of a fruity cocktail, I’d say, for all intents and purposes, I’m uncovered. Like, if your umbrella isn’t physically covering at least 50% of my body — sorry, but you don’t get to claim you’re covering me.

That’s about as much of a misuse of the word ‘cover’ as an ‘undercover’ cop rocking up to a druglord’s den wearing a big blue policeman’s hat. Or as a ‘bed cover’ which is actually the size of a sanitary pad.

It makes me wonder about the vulnerability of people with longer term medical costs, or stickier conditions like mental ill health — of which the uncertainty regarding insurance payouts may fuel the anxiety treatments are attempting to lessen.

I know what you’re thinking — “You didn’t read the fine print.”

And yes. You’re right.

I mean, I did read it. But I didn’t really absorb it. It was as dense as a fruit cake in a dying star.

So because they’d said “You’re covered”, I just thought, “Well, all this mumbo jumbo must be a weirdly roundabout way of saying I’m covered.”

This skirts a bigger question — how meaningful is the word ‘cover’ in the context of ‘health cover’ if you can asterisk it and disclaimer it and dump a cubic fuck-tonne of Legalese beneath it, to the point that it doesn’t mean what you and I would mean when we say the word, ‘cover’? In that case, you may as well say ‘complete cover’ as long as you caveat it to high heaven.

What do words even mean at that point? Call it ‘health zebra’ or ‘health bananas’. It’s about as arbitrary as ‘health cover’. (Just make sure when you asterisk it that the asterisk is actually 100% of an asterisk, not 5% of one.)

I’m getting too semantic here — so let’s return to that mental image from before: You’ve left the pub, $22 down. You’re standing in the rain. Your ‘mate’ is covering you with a teeny-tiny-tiki-sized umbrella. You can feel the water in your socks, and now you have a cold coming on.

Is that covered?