Posted on 03/19/2016 5:16:45 AM PDT by Kaslin
Late last year, while playing tennis, I reached up to serve and felt a painful pop in my shoulder. The inflammation got worse over the next few months. Now anytime I try to put my arm above my head, pain shoots up my arm. I often wake up at night with an agonizing throb in my shoulder.
So I finally and reluctantly went to the orthopedic surgeon; he said that I had a rotator cuff tear and I would probably need surgery. Ugh! He scheduled me for an MRI, but the day I was set to go, the hospital called to tell me my insurance company declined to pay for the scans. The insurance company, Cigna, tersely sent me a note: "You will need to complete six weeks of conservative treatment, such as physical therapy and anti-inflammatory medication. Once that has been completed and you have been re-evaluated, we can try to have the MRI re-authorized." Gee, thanks. You guys are the best.
I've been doing therapy for many months already, with not much improvement. The doctor explained that the insurance companies want to make sure that physicians aren't padding bills with unnecessary procedures. Incidentally, I've paid for health insurance for 30 years and have almost never used the medical care system. I calculate the insurers have made well over $100,000 off of me.
But I am lost inside the bureaucratic maze. They don't want to pay for the MRI because they don't want to have to reimburse for rotator cuff surgery. So their hope is that I will just go away. Studies show these delay tactics and bureaucratic runarounds work to reduce insurance payouts.
Everyone has horror stories of insurance companies denying coverage for valid procedures. As an analysis in The Baltimore Sun recently put it: "Among insurance professionals, it is common knowledge that health insurers are denying claims for coverage with increasing frequency." This is what the health industry calls "cost control."
Look, I get it; the insurance companies are trying to root out fraud and abuse of excessive procedures, which drive up costs for everyone. But the insurance companies are becoming barriers to care even for legitimate and necessary procedures.
What's the root of the problem here?
First, the excess of health insurance actually drives up cost. The more insurance for a procedure, the more expensive it is. Health inflation and premiums has been rising by nearly double the consumer price index for at least the last decade. This is also why there are so many frivolous procedures performed. Patients have been removed from the decision-making process.
Second, Obamacare has increased demand for health care and is driving up costs, so insurers appear to be cutting their expenses by denying claims more often. By the way, the insurance lobby should take note that this sleazy practice only plays into the hands of Bernie Sanders and others who want a single-payer government system to take over health insurance.
That will make medical care worse -- and more expensive. Studies on Medicaid patients find little or no improvement in health outcomes compared to the uninsured population -- because the level of care is so lousy. Government health care will be Medicaid-type coverage for all. It will be "fair" because we will all get equally subpar medical care -- and I would never get my shoulder surgery under that system.
The health insurance scandal in America today argues not for a vast expansion of government-run health care; instead, it suggests the wisdom of the medical savings account approach, where people put money, tax-free, into an IRA account and draw it down to pay for their first few thousand dollars of coverage. That way it isn't an insurance company who makes the call as to whether I should get an MRI. I make the call with my own money. Is the pain in my shoulder so bad that I want to shell out $1,200 to have a scan? Right now, Cigna says I don't get to make that choice. So it's "free" but I can't get it. Wonderful.
The only people who know whether I need surgery are not the faceless, bean-counting claims adjusters living in Toledo, Ohio, but my doctor and me
The real question: Is there a better way to get someone else to pay to my medical care? The best way to approach medical care is quite simple: Contract for services and pay for them yourself. It seems to work for almost everything else in our economy.
Given the stunts I've seen insurance companies pull, years before Obamacare, public demand for socialized medicine was an inevitable reaction.
I should think that the insurance companies would welcome being, in effect, nationalized. The managers currently in the industry would become government officials. Their employees would become infireable and unaccountable government employees.
Get rid of the lawyers and health care is cheap. Sorry, but you or your precious snowflake might not be worth $4.6 million if a doctor tries to treat you and the outcome isn’t perfect. My toddler and I once got the squirts in a third world country and went to the clinic. We got checked over and he got several extra tests because he was so young. We walked out with a sackful of meds and the total bill was $11. Suing over everything wasn’t known there and health care was affordable. The biggest expense most doctors have here is malpractice insurance.
You are probably correct. Rush doesn’t have health insurance (his choice) and pays the costs out of his own pocket.
“Cruz will repeal 0bamacare. What will Trump do?”
Beg your pardon, but not one objectionable law has been repeal over the last decades even when the GOP had the Houses.
There is no left or right; there is only one ideological group and we aren’t in it.
what a ridiculous article - 8th grader prolly.
Yeah you missed it. It was in the next to last paragraph where he wrote that he wants to shell out $1200 for the scan, but CIGNA told him it doesn’t work that way.
About half the states in the country have already enacted tort reform that caps malpractice awards. And while there is some evidence that the reforms have reduced medical malpractice insurance premiums there is no evidence that it has reduced health care premiums.
” Contract for services and pay for them yourself. It seems to work for almost everything else in our economy.” 23 and Me, does genetic testing that will tell what diseases you will get. You can adjust your like accordingly. The rest of your needs through Health Care Accounts. Science leapfrogs politics.
you are confused - look how many executive orders OblaBla has issued to support ACA. The next prez can issue another Exec Order rescinding all previous exec orders. Obamacare would self-implode.
Insurance companies negotiate lower prices because of volume and the assurance that the medical provider is going to get paid the agreed upon rate. Why should your doctor do that for an individual?
^5
Your article does not address any of the questions I raised. Would you like to try?
I am now over 65, and am required to have Medicare. Voilà, "free" insurance. This now means triple bills, one for Medicare, one for my Medgap, and one for me. The bills sometimes are pennies - less than the stamp to send it to me. Some procedures that I would be willing to pay for myself are impossible to get. My physician is not allowed to prescribe something that Medicare does not pay for. He loses his ability to bill all other Medicare bills for everyone, if he does.
There are billions to be saved by giving patients more control over their medical bills.
Unfortunately his insurance won’t let him pay for it.
The Trump Obamacare replacement plan is generally no different from most other Republican plans, other than he's quite late to the party, and is missing some critical pieces.
Precisely. In that regard it's just like a public education.
The big problem with healthcare is its cost, not how to pay for it
Sure nothing works. Carry on...
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