Tuesday, September 23, 2008

Medical Insurance

A hot topic these days for politicians is affordable health insurance for all Americans. That sounds good on the surface, but for it to be beneficial the entire system needs to be revamped. For those not familiar, let me explain the situation that exists, at least for me.

I currently have health insurance but that does not guarantee that I will receive quality medical care. Top doctors, particularly specialists, are not in my network. The majority of the providers that are in my network received their medical training somewhere like Haiti and operate their practice from a van they share with a carpet cleaning service. Cutting edge, state of the art procedures are not available to me. Blood letting, sorcery, and sacred dances are the treatments I can realistically expect.

The reason the best doctors do not choose to participate in my care is that they can’t make any money. If a doctor agrees to participate in a network it means he essentially allows the insurance carrier to dictate how much he will be paid.

Many actions are not covered and many others require pre-authorization in order to be covered. Let’s say I need a treatment that the doctor charges $2,500 for. If the course of action is covered the insurance company may only authorize $175 for that procedure. Between the insurance company and myself, we will pay the doctor $175. So the doctor must write-off $2,325. It is not hard to understand why the top doctors are not willing to play that game.

Should I choose to survive and visit an out-of-network doctor that actually has a fighting chance of curing what ails me, I am essentially on my own. The doctor bills me $2,500 and I am obligated to pay that amount regardless of whether my insurance company participates or not.

So if a few million additional sick people are dumped into that system, the few participating doctors will be so overwhelmed that the chances of actually seeing even the least qualified doctor prior to being pronounced dead becomes very slim. Countries with socialized medicine, such as England and Canada, have long waits for needed procedures.

Many of you have seen the television commercials for the Cancer Treatment Centers of America. They are amazing hospitals that boast the most advanced cancer treatment and an amazing success rate of cure. But most of us will never be able to afford that level of treatment. I took this statement directly from their website:

What are my responsibilities?
As a courtesy to you, we will file your insurance claim based on the information you provide. Your signature will be required to assign benefits directly to the hospital and physicians. We encourage patients to review their policy so there are no hidden surprises that might occur. We will work closely with you and your insurance company to expedite the process. Unfortunately, we may not always be able to obtain prompt or full payment from your insurance company. If that happens, you will be expected to assist in expediting the claim and resolving any balances due.
Why do I still have a balance if my insurance company pays 100% of Reasonable and Customary Charges?
Some insurance companies base payment on the average charges for all hospitals in a given area. This practice does not take into consideration the specialized nature of care at certain facilities managed by Cancer Treatment Centers of America and may not cover the full cost of the care you receive. You may be responsible for any balances. You are encouraged to discuss your coverage with your insurance company prior to treatment.
What are my payment options?
Since patients are financially liable for all medical services received, we offer alternatives for patients to pay their balances. The payment options may include cash, personal check, money order, credit cards and short-term payment plans. We accept Visa, Master Card and Discover. Should you have any open balances, you may be asked to pay them prior to further treatment.

It is exactly like everything else in life. You get what you pay for.


Redheels said...

It would be great if everyone had good affordable health insurance, but I doubt that will ever happen. I feel lucky to just have health insurance right now. My network has one GP in my area. I think you can see the quality of care I get.

You know this issue is something I think about every day.

Thanks for sharing your thoughts.

paisley said...

i have no health insurance.. fortunately for me i live in a small rural town with many undocumented workers and a generous spattering of land rich and money poor people... we have a clinic in town that will provide basic services based on income,, and as long as i maintain as near a zero income is as humanly possible.... i am covered at no charge to me...

now i have never done anything exotic like have tests or treatments,, just regular "sick" stuff... so i am not sure how any of that will play out... but i am considering trying at least a blood test or two.......

pia said...

I think of every problem America has and we have so many affordable good health care is at the center

I have been obsessing about SC heath insurance. My health insurance in NY is great but pricey. One of the big objectives of this move is too cut e_penses down while living a better quality of life

Roger Yale said...

Unbelievable, Rick, but true and a sad state of affairs indeed.

I have no health insurance. Considering a good life insurance policy so my kids will derive some sort of benefit if I go.

My kids have Medicaid, thank God - but I "make too much" to get myself covered.

If I make too much how come I break into a cold sweat when the rent is due?

barbie said...

I have no medical insurance hoping that my generation will get it soon. Since i live in a small town medical insurance has not reached importance so some steps may be taken so that people will be aware of it..
Barbie Purl

orionsbow said...

Why aren't YOU Heading the debate for a health care revamp in Washington? YOU know more about the system than any of the idiots we've hired to do it for us.

myrtle beached whale said...

It is just because I am IN the system.

Roger Yale said...

As a former medical claims examiner, I remember explaining our exclusions and limitations to folks who never read them - and got so heartsick about this that I could barely stand it. Especially when folks started talking about second mortgages or worseto cover these exclusions.