It truly amazes me how so many people can waste so much time doing so many ridiculous things when it comes to overhauling the health care system.  The answer is right in front of their nose but no one seems to really want to fix the problem.

Here’s the issue.  The legislators have written laws for the benefit of the insurance companies that preclude people from forming a group to buy health insurance.  The reason they do this is so that the insurance company can gouge the lowly individual for outrageous premiums because they can not presumably spread out the risk among a large group of people.

Baloney I say!

There are millions of people who have no health insurance because they can not afford the ridiculous premiums.  Therefore, they do not have any insurance.  When they get sick for any reason, they have to go to the emergency room to get basic care.   That makes alot of sense does it? 

It’s very simple – let the individuals in this country who want reasonable health insurance  create a group to buy health insurance – say the “people’s group”.  This group would then be 10-20 times larger than the biggest group in America today – Walmart – some 1 1/3 million.   It should not matter where you live – only in the US somewhere – period.

The “people’s group” would then buy ALL of their health insurance from one carrier – the one who gives them the best coverage for the LOWEST cost.  The company who won the bid would end up the largest health care insurance company in the US and would then set payout limits to doctors, hospitals, and pharmacies as to what they will pay for services rendered (just like Medicare/Medicaid does and just like they do already even though you do not know it.  If you don’t think so, read your last statement for medical payouts by the insurance carrier – they set the limit to payouts and claim that you “may” owe the rest.  The rest of what – gouge money?).

By doing this the rest of the insurance carriers would also have to fall in line as everyone else who realizes they are getting gouged will go over to this new “people’s group”.  This is simple supply and demand economics.  The large group keeps the costs down by the sheer size of the group and keeps their thumb on the back of the insurance company who holds the group when they “re-bid” the deal every year.

Technorati Tags: health care, health insurance

It’s bad enough that health insurance companies are ridiculously slow at paying health care providers for the services they are providing that are covered by your health insurance policy.  What’s worse is that they can wreck your credit score at the same time. 

Through personal experience I had one of those preventative internal exams that folks just love to get when they are older.  The procedure was cleared ahead of time by Horizon Blue Cross of New Jersey and all the costs were covered by their policy — they even provided and approval code.  Seems easy enough – doesn’t it. 

So time goes on and I received a statement from Horizon Blue Cross saying  that the procedure was not covered by my policy.  When I called them on the phone, the customer service representative said that the charges were in fact covered by my policy and they would “repost” the claim and it would be paid within the next two weeks.

Well,  after more than a few weeks I received a bill from the company performing the procedure that the fee was not paid by the insurance comany and that the charges were due to thje service provider.  Hmm ….. , this time I got both the provider and Horizon Blue Cross on the phone at the same time and they both understood that the Horizon would be paying charges after re-posting by the service provider.

However, the results we the same as the previous time and the charges were again denied by Horizon Blue Cross.  So again, I contacted Horizon and was told that they would correct the matter and pay the charges.  Horizon just appeared to give only “lip service” as this denied and “refiling” occurred several more times until I ended up with a bill from a debt collector. 

Now I am really getting PO’ed!  This time I contacted both the debt collector and Horizon Blue Cross and told them both what had happened — I moved up the ladder to the primary supervisor who said they would move it to the proper authority who would see that the claim was paid.   I went round and round with Horizon BC and the debt collector for a few more months trying to get this bill paid until finally I ended up with a summons to small claims court.

When this happened, I contacted Horizon Blue Cross Immediately and received the run-around yet again, but was told there was a procedure to make a formal appeal to have the case reviewed by some “higher authority”.  I send a certified letter to the Appeals Dept explaining what had happened.  Within a week the bill was paid by Horizon Blue Cross of NJ.

What they did not do, however, was pay the court costs for the summons that they caused through their inept service.  They also did nothing to help me out with my credit rating and this “collection notice” is now public record and does harm your credit rating.

Technorati Tags: credit rating, debt collector, health insurance

What really amazes me is how health insurance companies can get away with descriminating against sole proprietors and small business owners.  Why is it that if you work for yourself, you are unable to get group health insurance rates.  In New Jersey, about the only thing a sole proprietor can afford is a lousy HMO policy that basically pays nothing and makes your GP fill out a referral slip every time you have to blow you nose.  For a family of three, HMO rates run approximately $1200 per month for basic 80-20 converage and a $30 c0-pay.  Now, if that same person is an employee of a large company that does the same type of work, that person (or the companny for that matter) would be paying half as much.  The only difference between the two people is for whom the person work.  Work for yourself and pay through the nose or work for a large company and pay alot less.  Now, would someone please explain to me the rational of that? 

What’s even more ridiculous is the fact that the Health Insurance companies have given so much money to support the elections of “our” legislators are allowed to get away with this.  It’s no wonder why a National Health Care System has been talked about for a long time.  However, since legislators do not have to pay for any health insurance costs, it’s no skin off their nose to help their constituents stave off these escalating expenses.

It’s amazing how times have changed.  When I was a child, our family doctor actually made house calls.  Now, when you call the doctor’s office to make an appointment, you spend alot of time just trying to get someone to answer the phone.  The  primary reason for this is that your family doctor and their supporting staff no longer work for your benefit — they work for the health insurance companies – gratis.  

What makes this even more galling is the fact that the insurance companies keep raising insurance premiums while claiming that it costs them more and more to operate.  I don’t understand how they put forth such a ridiculous proposition when they dump most of their work on the primary care physicians.  Primary care physicians do not make any money filling out and processing “referrals”.  This is just a ploy by the insurance companies to use these “referals” as and excuse to not pay a claim.  If they actually provided the referals themselves, then they would not be able to deny the claim.  But hey, what do they care,  it costs money to pay the claim — heaven forbid they would have to do that.  Don’t let anyone fool you into thinking this current system is anything more than a fraudulent scam by insurance companies to pass off all their costs onto others while “claiming” higher costs. 

On reason the costs are higher than they should be is due to the amount of reprocessing that occurs with regard to insurance claims.  How many times have you spent hours on the phone with insurance company customer “service” (I use that term lightly)  representatives getting a claim reprocessed because the insurance company did not receive the “correct” information even though the procedure was pre-authorized and processed according to the instructions in the “referral”.  That is where the costs are frivously wasted — your premiums at work.