"Naruhodo" (なるほど) translated from Japanese means roughly "oh! now I get it." I write, therefore I understand. This blog is one avenue by which I ferret out the meaning of life, the universe, and everything....
Monday, April 14, 2008
"The Insurance Mafia"
This article by Jonathan Kellerman in the Wall Street Journal makes a very good point about the role of insurance (whether private or government-run) in health care.
2 comments:
Anonymous
said...
I don't know what Marie read, but I read a hissy socialist fit about the EVIL insurance companies. I found this because my business is "the insurance mafia" www.ihatebuyinginsurance.com I have worked in a pharmacy environment and now am one of the largest providers of health insurance in TN. So I have seen different sides of the "health care debate".
Let's look at only one of his comments. "Several years ago, I suffered a sports injury that necessitated an MRI. The "fee" for a 20-minute procedure was over $3,000. My insurance company refused to pay, so I informed the radiologist that I'd be footing the bill myself. Immediately, the "fee" was cut by two thirds. And the doctor was tickled to get it."
Well, he fails to mention anything about the agreed 'coverages' within his particular health insurance contract. Yes, contract. You signed up for it. If you didn't read it to see what is, and what is not covered, you're the fool. What was the deductible for the year? Had it been met? Did he need to visit a contracted MRI lab in order for the insurance carrier to pay? none of these are stated. he only implies that is "should have been paid for". He should have also learned the leason that he CAN bargain for medical services. We do it with cars, homes, tv's, and even small appliances. What has caused you to think that you can't shop for medical services. If an emergency, go where the ambulance takes you. Otherwise, just like looking for that new dryer....shop around. you will be surprised.
Let's examine what is "wrong with health care system and let's compare it to auto insurance.
#1 The biggest issue is how we "drive" our body. Would you expect your auto carrier to continuously pay for your neglect? If you say, drive over parking blocks daily, run into parking meters, backing into your neighbors mail box and so on? No. YOU are the health care crisis. 80% of all disease can be avoided by changing our "oral habits". #2 The second problem with health care is that somehow the mindset has become, "I shouldn't have to pay for the service I need". You want the "insurance" company to pay for EVERYTHING that goes wrong and do it for a co-pay. Do you expect the auto carrier to pay for your paint job once it starts to fade on your 12 year old car? If the water pump goes out after 80K miles, does Allstate say "Oh, we'll pay for that."???? Your cd player stops playing cd's....YOU are responsible for the maintenance. They pay for the UNKNOW. Accident. Hit and run. Theft. It is medical INSURANCE. Not a prepaid health expense plan.
Sometimes we can be struck by a disease that may not be related to our poor diet, lack of exercise, and poor habits like drugs, tobacco, and alcohol. Sometimes we fall of the roof. Either way, buy the best insurance for you budget. Just like you do with you home or auto. Even if it means a high deductible. What's the big deal to owe $10,000 once you cancer battle is over. The insurance carrier just paid HUNDREDS of thousands. Not bad for the $175 a month you were paying. I would enjoy sharing more to anyone who wants to debate the issue. DEBATE, not yell and scream about what a hater someone os because they don't think that everyone has a Right to the same coverage....
Multiple times a year my insurance company denies claims it is responsible (as stated in my contact with them) to pay. Each time I call them, point out their error, get them to correct it. (Once it was for a mammogram, shortly after I got a nice glossy mailer from them encouraging me to set my appointment for one. A no-brainer "covered", done at the right facility.) I wonder how many of these errors would be overlooked by other consumers and simply paid for. Even I have just given in and paid for the odd $10 that was not mine to pay, just out of weariness of constantly challenging everything.
But really, the point of the article as I saw it was about the relative value of using one's money directly for health care instead of paying the insurance middle man (hence the "mafia" reference). I absolutely agree that health consumers must take responsibility for their health, and I for one do not wish to pay higher and higher premiums because the vast majority of Americans do not wish to change their diet and exercise. But there is a "scare" element in our culture regarding insurance. We buy the line that spending this money will give us peace and security, when in reality a financial savings account and a cheap catastrophic coverage approach will serve many people well. This is the direction we have moved as a family, and we are saving money.
I would add, this scare factor element isn't necessarily the fault of those who sell insurance (unless they take advantage of people who think they need the cadillac version simply out of fear and irrationality). I think it is derived more from cultural factors.
Then there is the facet of how medical practices have changed based on the requirements insurance companies make of them (both health and liability insurances).
I believe that American medical culture needs to open its mind about many things. Insurance is but one of the troubles it faces.
2 comments:
I don't know what Marie read, but I read a hissy socialist fit about the EVIL insurance companies. I found this because my business is "the insurance mafia" www.ihatebuyinginsurance.com I have worked in a pharmacy environment and now am one of the largest providers of health insurance in TN. So I have seen different sides of the "health care debate".
Let's look at only one of his comments. "Several years ago, I suffered a sports injury that necessitated an MRI. The "fee" for a 20-minute procedure was over $3,000. My insurance company refused to pay, so I informed the radiologist that I'd be footing the bill myself. Immediately, the "fee" was cut by two thirds. And the doctor was tickled to get it."
Well, he fails to mention anything about the agreed 'coverages' within his particular health insurance contract. Yes, contract. You signed up for it. If you didn't read it to see what is, and what is not covered, you're the fool. What was the deductible for the year? Had it been met? Did he need to visit a contracted MRI lab in order for the insurance carrier to pay? none of these are stated. he only implies that is "should have been paid for". He should have also learned the leason that he CAN bargain for medical services. We do it with cars, homes, tv's, and even small appliances. What has caused you to think that you can't shop for medical services. If an emergency, go where the ambulance takes you. Otherwise, just like looking for that new dryer....shop around. you will be surprised.
Let's examine what is "wrong with health care system and let's compare it to auto insurance.
#1 The biggest issue is how we "drive" our body. Would you expect your auto carrier to continuously pay for your neglect? If you say, drive over parking blocks daily, run into parking meters, backing into your neighbors mail box and so on? No. YOU are the health care crisis. 80% of all disease can be avoided by changing our "oral habits".
#2 The second problem with health care is that somehow the mindset has become, "I shouldn't have to pay for the service I need". You want the "insurance" company to pay for EVERYTHING that goes wrong and do it for a co-pay. Do you expect the auto carrier to pay for your paint job once it starts to fade on your 12 year old car? If the water pump goes out after 80K miles, does Allstate say "Oh, we'll pay for that."???? Your cd player stops playing cd's....YOU are responsible for the maintenance. They pay for the UNKNOW. Accident. Hit and run. Theft. It is medical INSURANCE. Not a prepaid health expense plan.
Sometimes we can be struck by a disease that may not be related to our poor diet, lack of exercise, and poor habits like drugs, tobacco, and alcohol. Sometimes we fall of the roof. Either way, buy the best insurance for you budget. Just like you do with you home or auto. Even if it means a high deductible. What's the big deal to owe $10,000 once you cancer battle is over. The insurance carrier just paid HUNDREDS of thousands. Not bad for the $175 a month you were paying. I would enjoy sharing more to anyone who wants to debate the issue. DEBATE, not yell and scream about what a hater someone os because they don't think that everyone has a Right to the same coverage....
Hi Joe Graves,
Thanks for stopping by my blog.
Multiple times a year my insurance company denies claims it is responsible (as stated in my contact with them) to pay. Each time I call them, point out their error, get them to correct it. (Once it was for a mammogram, shortly after I got a nice glossy mailer from them encouraging me to set my appointment for one. A no-brainer "covered", done at the right facility.) I wonder how many of these errors would be overlooked by other consumers and simply paid for. Even I have just given in and paid for the odd $10 that was not mine to pay, just out of weariness of constantly challenging everything.
But really, the point of the article as I saw it was about the relative value of using one's money directly for health care instead of paying the insurance middle man (hence the "mafia" reference). I absolutely agree that health consumers must take responsibility for their health, and I for one do not wish to pay higher and higher premiums because the vast majority of Americans do not wish to change their diet and exercise. But there is a "scare" element in our culture regarding insurance. We buy the line that spending this money will give us peace and security, when in reality a financial savings account and a cheap catastrophic coverage approach will serve many people well. This is the direction we have moved as a family, and we are saving money.
I would add, this scare factor element isn't necessarily the fault of those who sell insurance (unless they take advantage of people who think they need the cadillac version simply out of fear and irrationality). I think it is derived more from cultural factors.
Then there is the facet of how medical practices have changed based on the requirements insurance companies make of them (both health and liability insurances).
I believe that American medical culture needs to open its mind about many things. Insurance is but one of the troubles it faces.
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