Is this procedure covered?
After “Am I going to die?”, and sometimes even before, “Is this procedure covered?” has to be one of the most asked question of Doctors. And, frankly, I resent it. I resent the fact that Insurance companies have forced their way into my Doctor/Patient relationship. I resent that they have the ultimate veto power over my health.
But, most importantly, I resent that I even have to think about Healthcare insurance.
Go ask anyone with a health condition how they are doing. I guarantee that their answer will veer towards their health insurance. They’ll tell you about their hassles with the insurance company, the number of bills they received marked as “not covered”, the number of phone calls they made trying to rectify the matter, and/or the amount they ended up paying out-of-pocket. Along the way you’ll meet a couple of people who boast of how they didn’t have to pay a cent – their ecstatic tone far more suited to winning a lottery than receiving an MRI.
And this is the problem. Health Insurance plays too big a role in Health Care. And since their goals are diametrically opposed somebody ends up losing. The loser is usually the patient who is either denied treatment or ends up paying for the denied treatment themselves.
Truth is, Health Insurance has nothing to do with your health. It has to do with making a profit. Their standard procedure seems to be deny, deny, deny, followed by delay, delay, delay – and hope that the patient grows weary of jumping through hoops and just pays the bill themselves.
In 1992, Allstate Insurance retained McKinsey. In fact, “McKinsey’s advice helped spark a turnaround in Allstate’s finances. The company’s profits rose 140 percent to $4.99 billion in 2006, up from $2.08 billion in 1996. Allstate lifted its income partly by paying less to its policyholders. Allstate spent 58 percent of its premium income in 2006 for claim payouts and the costs of the process, compared with 79 percent in 1996, according to filings with the U.S. Securities and Exchange Commission.” You might question how an insurance company can make such a dramatic increase in its profits in just four years.
During court proceedings McKinsey was forced to divulge 13,000 documents relating to the “advice” it provided Allstate. McKinsey told Allstate things like “sit and wait” regarding claims. Delaying claims could, and most likely did, discourage policyholders from pursuing their claims. This delay forced many policyholders to just walk away. One less claim to pay means one thing for insurance companies: more profit.
Insurance companies have run their business like a Las Vegas casino: The house always wins. It’s time to change the odds. How changing the odds manifests itself is still unknown. But what is known is that we can no longer afford the status quo, and the old bogeyman of the Right has been exposed as a lie. …Or am I the only one who remembers those 1990’s Harry and Lousie ads? Good thing we avoided those “gatekeepers” and price increases, eh?
Tags: Health Care
Regulations are badly needed. If we’re going to be stuck with this for-profit system we need to make sure that they answer claims in a timely manner and challenges as well. We especially need to get rid of the “pre-existing condition” loophole.
The unfortunate truth is that many, many people die in the U.S. of completely curable conditions because they don’t have insurance or their insurance is inadequate.
“I resent that they have the ultimate veto power over my health.”
Indeed, it’s sad that it has come to the point that the insurance companies dictate the schedule and timeliness of a course of treatment. I’m fortunate that I have some doctors who actually care about their patient and will often offer a workaround.
Example: After removing some cancerous spots from my skin, my dermatologist said, “You have more that will need to be removed shortly, but they’re not advanced enough now to be covered. However, if you tell me they are causing you any pain or discomfort… wink, wink.
We all must demand the European system for no other reason that they live longer than us. I know the GOP will always say that they have to wait but it appears to me with a longer life time the can afford to stand in line a while longer than us LOL
It’s very simple: One system would put power in the hands of administrators who don’t really care whether I get health care. The other puts power in the hands of administrators who have incentive to deny me health care.
I am thankful that the voters picked an honest Democrat for Insurance Commish.
(runs out of room to avoid rotten veggie tossing)
Although healthcare most likely plays a part in the higher life expectancy in Europe, I think their healthier diet and overall way of life plays a larger part.
What is interesting about the best of the European health care systems is that they are insurance-based. In France, it is a government run system that everyone pays into (except for the very poor) and asks for modest copays for most procedures. The sicker you are, the fewer your out of pocket expenses. And they don’t get to deny you coverage or procedures. You can get private insurance to cover copays and work not covered under the national insurance — eyeglasses, and so on. They haven’t been shielded from the cost escalations, which they are struggling with, but this is health care that does work.
The Germans buy into private (non-profit) insurance — all of them. You and your employer pay a percentage of your salary and you get all of the health care you need. The government’s role is to make sure the insurers treat everyone fairly. Again, no denials of care, no chasing down payments. Both systems negotiate fees for service on your behalf — but they can’t tell you that you can only get your kids a checkup every two years.
Getting rid of the gate keepers whose only job is to tell you NO is a good idea, especially if we get a system where everyone has to have coverage. How you control the costs — which is the driver of it all — I’m not so sure of.
What’s infuriating is part of an insurance company’s strategic plan is to tell you “no” and hope you go away.