Doctors don't make money if people don't go to see them. People don't go to see them because they aren't insured. I'm sorry, but denying claims because someone mistyped the letter O instead of a zero doesn't make me weep for the insurance company. Laws are wonderful things but when they start verging on the ridiculous they start to be used as hedges of thorns behind which simple things that CAN be done AREN'T done because of "the law".
The statement that insurance companies do their best to "keep people healthy" makes no SENSE. Paying sky-high premiums and then being denied coverage when you really need it is keeping people healthy HOW? The insurance companues are really in the business of keeping people healthy? REALLY? Well let me posit a few ways in which they can do this.
1) reduce the profit margin. This is not the stock market. These are people's lives. Reduce the premiums and more people will buy in, which means that the thing equalises out eventually. You might have to wait a little longer for the loot to line your own pockets with. LIVE WITH IT. That's the business you're in.
2) consolidate. Have health insurance be fricking HEALTH INSURANCE. Take out extra dental insurance, extra insurance for eyeglasses, or hearing aids, or orthopedics. It's all covered... under a single HEALTH INSURANCE. You buy into a plan which has branches in all the things that are commonly known as medicine. your basic health insurance premium is high enough without folks like dental insurance people coming along and saying, oh, fork out an extra couple of hundred, and you get to go see the dentist when you actually need that broken tooth fixed.
3) stop hiding behind "the law". The insurance companies have PLENTY of power to change laws which are counterproductive - far more power than the average man in the street has. Put your own safeguards in place if you need to. Hire competent people who might actually make an extra phone call to verify someone's identity rather than just rubberstamping a claim "denied" and sending it back out the door.
4) disallow recission and the iniquitous "pre existing condition" clause. What, if you're already sick you should just die already and save everyone the trouble? It's HEALTH INSURANCE. It's there to help when you're sick. The only people to get any benefits out of it when you are NOT sick are the insurance companies.
My (catastrophic) health insurance premium is climbing fast. I cannot even think about dental (and I looked at it, and frankly I don't know why they bother - most of the big-ticket items for which I would need insurance help for, such as implants, are very very selectively covered by insurance. Which is why I recently spent THOUSANDS of dollars of my own money for a crown. I can't AFFORD dental insurance, my dear.
The system is broken. It may need to get more broken before it is fixed - in an era of high job losses it might stick in the craw to create more losses by streamlining the insurance industry. But it's BLOATED, like a tick. It seems its only useful function these days is to keep a handful more people employed.... but let me tell you something. If things don't change, there aren't going to be enough of us out here who will be able to subsidise those of you who wield the "denied" rubber stamp. ANd there will be job losses anyway.
We need that public option. No matter how much the ignorant, the venal, and those who are simply desperately seeking to hang onto the status quo because of an "i'm all right jack" attitude might wail and tear their clothes about it - there are people out there who are really hurting. The word "denied" means far more to them than a rubber stamp. Most of them wouldn't know the difference between an O and a 0 (that's a capital O and a zero. Can you really tell the difference?)
First of all, we do call to verify patient information. However, if I pay the claim and it's found out, we will be fined a MINIMUM of 50,000 for paying the claim before it IS verified. (the denial message, btw, says please check your ID card and send it again) I'm not hiding behind the law. I'm just not stupid enough to tangle with it.
Second of all, our company allows the people buying the insurance to decide whether or not preexisting applies. And we're working on combining all the specialties into single insurance and have been rolling it out in multiple states.
Third, we are in Congress doing our level best to convince them to allow us to pay those kinds of claims that it's ridiculous and stupid to deny, but you might be surprised to know that lawmakers don't really seem to care.
Fourth, not everyone can afford insurance. I was one of those until I went to work here. That's why I prefaced this whole thing with "I am for a public option. I just don't want them to make the private system even worse." 'Cause they will. The current provisions will push more options out of the market. And we need those options too.
Fifth, I wrangle daily to try and find ways to pay the claims that if automated would be denied. It's not a rubber stamp to me. And if I just can't pay it, I send a customer service note to tell them how else they can get it paid. A lot of things in dental ARE covered in medical now and people don't know it. Surgical extractions. Grinding the teeth (oddly, not a dental thing most of the time), etc.
Sixth, (and truly finally, then I'm getting off this topic as it would take a college course to really get to the bottom of all the complicating factors), do you know that a lot of insurance now provides standard preventative measures 100% covered, no deductible, copays, or out-of-pocket? We do community events for checkups free. (Not in every city, but a lot of the major ones.) There isn't MUCH anyone can do within the lousy constraints set up for us to forcibly keep people healthy, but we DO do our best, as a company (medical and everything else insurance). And we keep trying to get better. Some of the ideas on the table to be implemented I think would please even you.
The truth is it's broken. But within the constraints we have, you can't say you KNOW we aren't trying. Only we can say if we are or not. And we are.
As for reducing our profit margins, goodness sake, how ARE we supposed to implement new ideas to help the ones we do insure if we have no working capital? Go down to one cent on the dollar? We're making just enough to keep serving people better.
And that was really my only point.
(Sorry it got so longwinded. I just wish more people knew how everything really worked together. But most people either don't or don't believe it.)
"...a lot of insurance now provides standard preventative measures 100% covered, no deductible, copays, or out-of-pocket?"
A LOT of them? Can't say I've tripped over many. And, um, here's a scenario. Your Joe Schmoe goes up to a "Free" medical, and they tell him, you've got X. His insurance company which might have provided the preventative measure out of the goodness of their hearts then finds a way to eel out of actually paying for TREATING X in any meaningful way.
Preventative is all very well. It prevents, up to a point. But once again, when you really need insurance is in the hour that preventative is no longer an option - when you've HAD the stroke, or the accident, or whatever, and you need them to pay the THOUSANDS UPON THOUSANDS it will cost to treat it. A broken leg should NOT cost tens of thousands of dollars in care, anyway - but at least insurance will cover something like that, and it isn't always "preventable" - that's why it's called an accident...
"Some of the ideas on the table to be implemented I think would please even you."
The statement that insurance companies do their best to "keep people healthy" makes no SENSE. Paying sky-high premiums and then being denied coverage when you really need it is keeping people healthy HOW? The insurance companues are really in the business of keeping people healthy? REALLY? Well let me posit a few ways in which they can do this.
1) reduce the profit margin. This is not the stock market. These are people's lives. Reduce the premiums and more people will buy in, which means that the thing equalises out eventually. You might have to wait a little longer for the loot to line your own pockets with. LIVE WITH IT. That's the business you're in.
2) consolidate. Have health insurance be fricking HEALTH INSURANCE. Take out extra dental insurance, extra insurance for eyeglasses, or hearing aids, or orthopedics. It's all covered... under a single HEALTH INSURANCE. You buy into a plan which has branches in all the things that are commonly known as medicine. your basic health insurance premium is high enough without folks like dental insurance people coming along and saying, oh, fork out an extra couple of hundred, and you get to go see the dentist when you actually need that broken tooth fixed.
3) stop hiding behind "the law". The insurance companies have PLENTY of power to change laws which are counterproductive - far more power than the average man in the street has. Put your own safeguards in place if you need to. Hire competent people who might actually make an extra phone call to verify someone's identity rather than just rubberstamping a claim "denied" and sending it back out the door.
4) disallow recission and the iniquitous "pre existing condition" clause. What, if you're already sick you should just die already and save everyone the trouble? It's HEALTH INSURANCE. It's there to help when you're sick. The only people to get any benefits out of it when you are NOT sick are the insurance companies.
My (catastrophic) health insurance premium is climbing fast. I cannot even think about dental (and I looked at it, and frankly I don't know why they bother - most of the big-ticket items for which I would need insurance help for, such as implants, are very very selectively covered by insurance. Which is why I recently spent THOUSANDS of dollars of my own money for a crown. I can't AFFORD dental insurance, my dear.
The system is broken. It may need to get more broken before it is fixed - in an era of high job losses it might stick in the craw to create more losses by streamlining the insurance industry. But it's BLOATED, like a tick. It seems its only useful function these days is to keep a handful more people employed.... but let me tell you something. If things don't change, there aren't going to be enough of us out here who will be able to subsidise those of you who wield the "denied" rubber stamp. ANd there will be job losses anyway.
We need that public option. No matter how much the ignorant, the venal, and those who are simply desperately seeking to hang onto the status quo because of an "i'm all right jack" attitude might wail and tear their clothes about it - there are people out there who are really hurting. The word "denied" means far more to them than a rubber stamp. Most of them wouldn't know the difference between an O and a 0 (that's a capital O and a zero. Can you really tell the difference?)
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Second of all, our company allows the people buying the insurance to decide whether or not preexisting applies. And we're working on combining all the specialties into single insurance and have been rolling it out in multiple states.
Third, we are in Congress doing our level best to convince them to allow us to pay those kinds of claims that it's ridiculous and stupid to deny, but you might be surprised to know that lawmakers don't really seem to care.
Fourth, not everyone can afford insurance. I was one of those until I went to work here. That's why I prefaced this whole thing with "I am for a public option. I just don't want them to make the private system even worse." 'Cause they will. The current provisions will push more options out of the market. And we need those options too.
Fifth, I wrangle daily to try and find ways to pay the claims that if automated would be denied. It's not a rubber stamp to me. And if I just can't pay it, I send a customer service note to tell them how else they can get it paid. A lot of things in dental ARE covered in medical now and people don't know it. Surgical extractions. Grinding the teeth (oddly, not a dental thing most of the time), etc.
Sixth, (and truly finally, then I'm getting off this topic as it would take a college course to really get to the bottom of all the complicating factors), do you know that a lot of insurance now provides standard preventative measures 100% covered, no deductible, copays, or out-of-pocket? We do community events for checkups free. (Not in every city, but a lot of the major ones.) There isn't MUCH anyone can do within the lousy constraints set up for us to forcibly keep people healthy, but we DO do our best, as a company (medical and everything else insurance). And we keep trying to get better. Some of the ideas on the table to be implemented I think would please even you.
The truth is it's broken. But within the constraints we have, you can't say you KNOW we aren't trying. Only we can say if we are or not. And we are.
As for reducing our profit margins, goodness sake, how ARE we supposed to implement new ideas to help the ones we do insure if we have no working capital? Go down to one cent on the dollar? We're making just enough to keep serving people better.
And that was really my only point.
(Sorry it got so longwinded. I just wish more people knew how everything really worked together. But most people either don't or don't believe it.)
Reply
A LOT of them? Can't say I've tripped over many. And, um, here's a scenario. Your Joe Schmoe goes up to a "Free" medical, and they tell him, you've got X. His insurance company which might have provided the preventative measure out of the goodness of their hearts then finds a way to eel out of actually paying for TREATING X in any meaningful way.
Preventative is all very well. It prevents, up to a point. But once again, when you really need insurance is in the hour that preventative is no longer an option - when you've HAD the stroke, or the accident, or whatever, and you need them to pay the THOUSANDS UPON THOUSANDS it will cost to treat it. A broken leg should NOT cost tens of thousands of dollars in care, anyway - but at least insurance will cover something like that, and it isn't always "preventable" - that's why it's called an accident...
"Some of the ideas on the table to be implemented I think would please even you."
They'll lower my premium...?
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