The Moderate Voice - Latest Comments in Health Care a Different Experience for the Privileged

Re: Health Care a Different Experience for the Privileged

denisedh — Sat, 01 Aug 2009 17:57:29 -0000

I am a mental health care provider and I can tell you that many insurance companies don&#39t bother researching patient histories in order to deny care, they simply refuse to cover certain serious, often chronic problems including eating disorders (anorexia and bulimia) and ADHD, for example. So, if your employer chooses one of those companies and your son or daughter develops either of these conditions, you will not be able to use insurance to cover their treatment. Children with eating disorders get better coverage on Medicaid than most insurance; the nightmare of having a child with a life-threatening psychiatric illness is compounded for parents who cannot pay for treatment although they are insured.
I am also on the board of a non-profit small company who provides contract mental health treatment services and review the budget as part of my duties; the only costs rising out of control are the health insurance premiums for the small staff. Premiums are over $6000 per year for 2 staff members; the program has had to change insurance companies repeatedly due to premium costs.
I would be in full time private practice were it not for the cost of my health insurance premiums and the fact that a good portion of my work time would be devoted to filling out piles of paperwork to be on insurance company panels, waiting "on hold" for long periods to beg someone for a few more sessions for a patient, etc., and i should note that these experiences occur even with excellent administrative support in the practice with which I am affiliated.

Re: Health Care a Different Experience for the Privileged

adelinesdad — Sat, 01 Aug 2009 13:21:12 -0000

alphosegaston,

If we made it easier for people to buy health insurance for themselves, instead of needing to rely on their employers to provide them with it, then your friends could have shopped around for a plan that would suit them. The problem your friends had was not with insurance companies--it was with a system that discourages choice. I once had a bad experience with a major electronics retailer. From that point forward, I stopped shopping at that retailer. (Incidentally, that retailer recently went out of business, but I assume I&#39m not directly responsible for that:)). That&#39s how the free market is supposed to work. If consumers have a true choice, companies compete for their business, both by providing a better product or server, and by keeping prices competitive. The current system discourages choice by tying health insurance to employment, and also by creating regulation that makes it difficult for start-up companies to enter the market in order to provide more competition.

Re: Health Care a Different Experience for the Privileged

denisedh — Sat, 01 Aug 2009 12:57:29 -0000

I am a mental health care provider and I can tell you that many insurance companies don't bother researching patient histories in order to deny care, they simply refuse to cover certain serious, often chronic problems including eating disorders (anorexia and bulimia) and ADHD, for example. So, if your employer chooses one of those companies and your son or daughter develops either of these conditions, you will not be able to use insurance to cover their treatment. Children with eating disorders get better coverage on Medicaid than most insurance; the nightmare of having a child with a life-threatening psychiatric illness is compounded for parents who cannot pay for treatment although they are insured.
I am also on the board of a non-profit small company who provides contract mental health treatment services and review the budget as part of my duties; the only costs rising out of control are the health insurance premiums for the small staff. Premiums are over $6000 per year for 2 staff members; the program has had to change insurance companies repeatedly due to premium costs.
I would be in full time private practice were it not for the cost of my health insurance premiums and the fact that a good portion of my work time would be devoted to filling out piles of paperwork to be on insurance company panels, waiting "on hold" for long periods to beg someone for a few more sessions for a patient, etc., and i should note that these experiences occur even with excellent administrative support in the practice with which I am affiliated.

Re: Health Care a Different Experience for the Privileged

adelinesdad — Sat, 01 Aug 2009 08:21:12 -0000

alphosegaston,

If we made it easier for people to buy health insurance for themselves, instead of needing to rely on their employers to provide them with it, then your friends could have shopped around for a plan that would suit them. The problem your friends had was not with insurance companies--it was with a system that discourages choice. I once had a bad experience with a major electronics retailer. From that point forward, I stopped shopping at that retailer. (Incidentally, that retailer recently went out of business, but I assume I'm not directly responsible for that:)). That's how the free market is supposed to work. If consumers have a true choice, companies compete for their business, both by providing a better product or service, and by keeping prices competitive. The current system discourages choice by tying health insurance to employment, and also by creating regulation that makes it difficult for start-up companies to enter the market in order to provide more competition.

Re: Health Care a Different Experience for the Privileged

alphonsegaston — Sat, 01 Aug 2009 07:30:17 -0000

I am also on Medicare, and it works very well. In addition I have an excellent secondary payer and a decent income from my professional career. So to hell with other people? Is that it?

Over the years I have heard many stories from my younger and poorer friends about health insurance problems. One of the worst is the young couple, both on the husband&#39s employee insurance plan, who both had serious asthma. The company did not see why they had to give them both rescue inhalers--as it they were together all the time! Also, the young woman had juvenile diabetes (most of her life--and she was then 21). The company refused to allow the type of insulin care her long-term physician ordered, which of course infuriated him. Naturally, when the young man lost his job, they could not get any kind of insurance to cover their needs as they had prior conditions which could not be covered. Many diabetics whom I know have little or no chance to get coverage unless they have a good employee plan like the federal government has for its workers.

But tough luck, right?

Re: Health Care a Different Experience for the Privileged

adelinesdad — Sat, 01 Aug 2009 05:04:18 -0000

"It is routine for insurance companies to require inexpensive tests before authorizing more appropriate but more expensive ones. This requirement wastes time and money in many cases — time and money that could be helping a patient who is in pain."

So we should order the more expensive one first? What if the cheaper one is able to make the expensive one not necessary most of the time? Doesn&#39t this contradict the recent talking point from the left--that we pay for too many unnecessary tests as it is. You&#39ve just disproven that point by showing that insurance companies already have an incentive to control costs by limiting potentially unnecessary testing. If you have evidence that we would save money by going straight to the MRI, I&#39m sure the insurance companies would love to see it.

"It is routine for insurance companies to require authorization for many treatments, and this authorization may require your doctor to submit piles of paperwork and sit on the phone for an hour."

Although I think there can be improvements in this area, I think it&#39s fair to say you&#39re exaggeration a bit. And if the alternative is to just authorize everything without question, that doesn&#39t sound like the plans from the left either. Obama constantly repeats how we should stop doing tests that have proven to be wasteful. That means someone&#39s going to have to make that decision, and my guess is it might require some paperwork.

"And as for the development of new treatments, I would like to point out that not a single new drug, not a single new treatment, not a single scientific breakthrough has ever been made by an insurance company."

Yes, and not a single car has ever been produced by an auto insurance company.

"Pharmaceutical companies, research universities, and innovative physicians/scientists will continue to do these things, and their discoveries will continue to be tested scientifically before being administered to the general population."

And the new procedures and medications will need to be paid for, and often they will be more expensive than the average consumer can pay for out of pocket, therefore, there is the need for a third party that is willing to take on the risk of needing to pay for these things for a particular patient, in exchange for the patient paying a monthly sum of money. We&#39ll call these third parties... insurance companies.

(Please note: I have made clear before, and I make clear again, that I recognize that our system needs changing. I&#39ve made my positions clear on other threads before, and I believe my proposed changes are actually more significant than Obama&#39s. In an issue as complicated as this, it is impossible to outline one&#39s entire position in one comment in a blog post. So before anyone claims that I&#39m defending the status quo, please search some of the previous threads. My point here is to argue against the point that the insurance companies are worthless and are making the system worse. Is there room for them to improve? Yes. Should we impose some regulation on them to make the system better? Yes. Are they responsible for all of our woes? No.)

Re: Health Care a Different Experience for the Privileged

Dr J — Sat, 01 Aug 2009 03:11:04 -0000

Roro, it&#39s hard to believe because for several reasons. First, no one making allegations like this has produced any real numbers, just whole ranges of stories describing a bunch of different things. "Resisted paying one of my claims" (but in the end paid it) is quite different from "refused to pay for treatments I knew the policy didn&#39t cover," and from "mistakenly denied something that should have been covered," and from "deliberately denied contractually-obligated treatment and stalled with lawyers until grandma died." These cover the range from fraud to honest mistakes to customer opportunism, and I&#39ll bet they have all happened, but only one constitutes real fraud. I think health insurers have way too much power in our current health care system, but I&#39m not prepared to agree that every contractual dispute is evidence of fraud.

Second, the verdict against insurance companies doesn&#39t make sense on its own, because the fraud business model simply doesn&#39t work. Your "they have lawyers" argument doesn&#39t explain how health insurers are uniquely able to make fraud pay, because *every* company has lawyers. Health insurers do indeed have customers evaluating them, though they&#39re more often HR departments than consumers (a serious deficiency we should fix, but I&#39ve already written about that). Perhaps you&#39re suggesting HR departments don&#39t care whether they&#39re signing an honest insurer or a fly-by-night outfit? If they do the latter, they are themselves exposed to lawsuits. Job number one in every HR department is keeping the company out of court.

Finally, your claim is hard to believe because it&#39s so convenient. It plays into the corporations-are-evil-you-must-trust-the-government mantra of leftists so tidily that if it weren&#39t true they would have a strong temptation to make it up. I&#39m not really suggesting they did, but I am suggesting a rumor has evolved from somewhere, it&#39s in their interests not to ask too many questions about it, and they haven&#39t.

Re: Health Care a Different Experience for the Privileged

alphonsegaston — Sat, 01 Aug 2009 02:30:17 -0000

I am also on Medicare, and it works very well. In addition I have an excellent secondary payer and a decent income from my professional career. So to hell with other people? Is that it?

Over the years I have heard many stories from my younger and poorer friends about health insurance problems. One of the worst is the young couple, both on the husband's employee insurance plan, who both had serious asthma. The company did not see why they had to give them both rescue inhalers--as it they were together all the time! Also, the young woman had juvenile diabetes (most of her life--and she was then 21). The company refused to allow the type of insulin care her long-term physician ordered, which of course infuriated him. Naturally, when the young man lost his job, they could not get any kind of insurance to cover their needs as they had prior conditions which could not be covered. Many diabetics whom I know have little or no chance to get coverage unless they have a good employee plan like the federal government has for its workers.

But tough luck, right?

Re: Health Care a Different Experience for the Privileged

roro80 — Sat, 01 Aug 2009 02:20:24 -0000

Also, Dr. J: Really? Why is this so hard to believe? There&#39s motive, practically nobody doesn&#39t have an eye-witness account, we&#39ve got the bodies, so really the only question is: since we&#39ve got to have guns around, is there anyone safer to hold it than the insurance companies?

Ok, my analogy sucks, but still. I have some of the best insurance out there, plus I&#39m a young and healthy white person with and excellent job but no children [read all: "I am highly priviledged"] and I STILL can&#39t count on one hand the number of times my insurance tried to get out of paying one of my claims. Since we all have multiple stories like this (c&#39mon, you know you do!), why is it all surprising that people who aren&#39t young and healthy and willing to sit on the phone for hours or maybe don&#39t speak English well or just aren&#39t quite as loudmouthed as I am or can&#39t afford to hire a lawyer or whatEVER -- why is so hard to believe that those people might have a hard time getting their appointments and treatments and medications paid for?

Re: Health Care a Different Experience for the Privileged

kathykattenburg — Sat, 01 Aug 2009 02:15:01 -0000

And how does having a government single payer system increase freedom and competition?

In a single-payer system, if you need to see a doctor or if you have an emergency, you just walk into the doctor&#39s office or the hospital ER, show them your card, and get taken care of. You don&#39t have to worry about how to pay for it or whether your insurance policy will cover it. Freedom remains. Choice remains. The only thing that leaves is the worry of being saddled with mountains of medical debt.

Re: Health Care a Different Experience for the Privileged

roro80 — Sat, 01 Aug 2009 01:59:28 -0000

DrJ:
1. "why haven&#39t their customers dried up?" As the post explains, most people don&#39t really have much choice, and by the time they come up against this problem, they&#39re already sick, which means other insurance companies won&#39t take them.

2. "Why don&#39t they do business this same way?" Generally speaking, they do. Not to everyone, not every time, only when they think they have a good strong case for getting away with it.

3. "Why haven&#39t they shut health insurers down?" First: good question. Second: insurance companies have excellent lawyers.

"Are there any actual statistics on what fraction of claims insurers fraudulently deny?"
Ah, see, here&#39s where those lawyers come in. They would object to your use of the word "fraudulently". Your "fraudulently" would be their "totally justafiably".

Re: Health Care a Different Experience for the Privileged

roro80 — Sat, 01 Aug 2009 01:51:13 -0000

"And how does having a government single payer system increase freedom and competition?"

Um... there are reasons such a system would increase "freedom" (whatever that is), but it certainly doesn&#39t increase competition. It&#39s not supposed to.

What I&#39m trying trying to figure out is how such a question, qwert, has to do with this post? I don&#39t see anyone, within the context of this post, has said anything about single payer at all.

If you need a summary of this post, here&#39s a quick-n-dirty stab at it, since maybe you forgot to read it: Person in WSJ says "my insurance is awesome, so everyone&#39s insurance must be awesome, so don&#39t change the system". Author of post says "well ain&#39t that special that you&#39ve got great insurance, but in the real world down here on the ground, most Americans aren&#39t quite so lucky; here&#39s the evidence of that". Actually, instead of "lucky", the post uses the word "priviledged", which is indeed the perfect word.

Notice: no talk of single payer. What&#39s the logical fallacy for making an argument against a point that isn&#39t being argued?

Re: Health Care a Different Experience for the Privileged

Dr J — Sat, 01 Aug 2009 01:43:23 -0000

JL, I don&#39t know how we could forget that since the Michael Moorists are so handy with anecdotes about it, and no doubt it has actually happened.

But the claim that insurance companies habitually deny contractually-promised coverage has the ring of an urban legend: a scary story that imparts a strong moral but doesn&#39t quite add up. Consider:

1. Established companies generally avoid fraud because they&#39re concerned about their brand and reputation. If health insurers make a habit of cheating people, why haven&#39t their customers dried up?

2. Other types of insurance companies have the same profit motive and face the same temptation to deny coverage after the fact. Why don&#39t they do business this same way?

3. States have regulatory bodies that do nothing but oversee insurance companies and investigate claims of contract violation. Why haven&#39t they shut health insurers down?

Are there any actual statistics on what fraction of claims insurers fraudulently deny?

Re: Health Care a Different Experience for the Privileged

JLBell — Sat, 01 Aug 2009 00:20:11 -0000

Let us not forget hat insurance companies do not make money by providing coverage; they make money by denying it. If there happens to be any health issue in Myrna&#39s past that she has either forgotten about or didn&#39t properly date the incident when she filled out the acceptance forms or history forms, there is always a full-time employee of every insurance company who&#39s only job is to research patient histories until they find a reason to deny or revoke coverage. If they fail to find such a reason, they will resort to restricting total cost output toward any and every insured individual by capping the dollar amount of coverage available based upon the type of policy they are covered by (or almost covered by).

Re: Health Care a Different Experience for the Privileged

qwert321 — Sat, 01 Aug 2009 00:12:50 -0000

"Most people do not have freedom, but rather they have limited choices for their doctor and hospital."

And how does having a government single payer system increase freedom and competition?

Re: Health Care a Different Experience for the Privileged

adelinesdad — Sat, 01 Aug 2009 00:04:18 -0000

So we should order the more expensive one first? What if the cheaper one is able to make the expensive one not necessary most of the time? Doesn't this contradict the recent talking point from the left--that we pay for too many unnecessary tests as it is. You've just disproven that point by showing that insurance companies already have an incentive to control costs by limiting potentially unnecessary testing. If you have evidence that we would save money by going straight to the MRI, I'm sure the insurance companies would love to see it.

"It is routine for insurance companies to require authorization for many treatments, and this authorization may require your doctor to submit piles of paperwork and sit on the phone for an hour."

Although I think there can be improvements in this area, I think it's fair to say you're exaggeration a bit. And if the alternative is to just authorize everything without question, that doesn't sound like the plans from the left either. Obama constantly repeats how we should stop doing tests that have proven to be wasteful. That means someone's going to have to make that decision, and my guess is it might require some paperwork.

"And as for the development of new treatments, I would like to point out that not a single new drug, not a single new treatment, not a single scientific breakthrough has ever been made by an insurance company."

Yes, and not a single car has ever been produced by an auto insurance company.

"Pharmaceutical companies, research universities, and innovative physicians/scientists will continue to do these things, and their discoveries will continue to be tested scientifically before being administered to the general population."

And the new procedures and medications will need to be paid for, and often they will be more expensive than the average consumer can pay for out of pocket. Therefore, there is the need for a third party that is willing to take on the risk of needing to pay for these things for a particular patient, in exchange for the patient paying a monthly sum of money. We'll call these third parties... insurance companies.

(Please note: I have made clear before, and I make clear again, that I recognize that our system needs changing. I've made my positions clear on other threads before, and I believe my proposed changes are actually more significant than Obama's. In an issue as complicated as this, it is impossible to outline one's entire position in one comment in a blog post. So before anyone claims that I'm defending the status quo, please search some of the previous threads. My point here is to argue against the point that the insurance companies are worthless and are making the system worse. Is there room for them to improve? Yes. Should we impose some regulation on them to make the system better? Yes. Are they responsible for all of our woes? No.)

Re: Health Care a Different Experience for the Privileged

RememebrNovember — Fri, 31 Jul 2009 22:37:04 -0000

yes, we all talk about choice, but forget that "out of network" means you have the choice to pay more for the doctor you really want, or the one you have been seeing for the past year but can&#39t thanks to your employer changing insurance on you, thus screwing you over for a better relationship with another insurance company ( yes, this is sour grapes talking) So you have to go over your entire health history again with a complete stranger. Or your doctor, sick of dealing with the insurance company shell game, decides he will take his services private and you can become a "member" of his patient club ( while still billing the insurance company anyway) so he can focus more on a core level of patients. Who wins?

Answer:

Lobbyists, hands down.

Re: Health Care a Different Experience for the Privileged

Gootmud — Fri, 31 Jul 2009 22:11:04 -0000

Roro, it's hard to believe because for several reasons. First, no one making allegations like this has produced any real numbers, just whole ranges of stories describing a bunch of different things. "Resisted paying one of my claims" (but in the end paid it) is quite different from "refused to pay for treatments I knew the policy didn't cover," and from "mistakenly denied something that should have been covered," and from "deliberately denied contractually-obligated treatment and stalled with lawyers until grandma died." These cover the range from fraud to honest mistakes to customer opportunism, and I'll bet they have all happened, but only one constitutes real fraud. I think health insurers have way too much power in our current health care system, but I'm not prepared to agree that every contractual dispute is evidence of fraud.

Second, the verdict against insurance companies doesn't make sense on its own, because the fraud business model simply doesn't work. Your "they have lawyers" argument doesn't explain how health insurers are uniquely able to make fraud pay, because *every* company has lawyers. Health insurers do indeed have customers evaluating them, though they're more often HR departments than consumers (a serious deficiency we should fix, but I've already written about that). Perhaps you're suggesting HR departments don't care whether they're signing an honest insurer or a fly-by-night outfit? If they do the latter, they are themselves exposed to lawsuits. Job number one in every HR department is keeping the company out of court.

Finally, your claim is hard to believe because it's so convenient. It plays into the corporations-are-evil-you-must-trust-the-government mantra of leftists so tidily that if it weren't true they would have a strong temptation to make it up. I'm not really suggesting they did, but I am suggesting a rumor has evolved from somewhere, it's in their interests not to ask too many questions about it, and they haven't.

Re: Health Care a Different Experience for the Privileged

roro80 — Fri, 31 Jul 2009 21:20:24 -0000

Also, Dr. J: Really? Why is this so hard to believe? There's motive, practically nobody doesn't have an eye-witness account, we've got the bodies, so really the only question is: since we've got to have guns around, is there anyone safer to hold them than the insurance companies?

Ok, my analogy sucks, but still. I have some of the best insurance out there, plus I'm a young and healthy white person with an excellent job but no children [read all: "I am highly priviledged"] and I STILL can't count on one hand the number of times my insurance tried to get out of paying one of my claims. Since we all have multiple stories like this (c'mon, you know you do!), why is it all surprising that people who aren't young and healthy and willing to sit on the phone for hours or maybe don't speak English well or just aren't quite as loudmouthed as I am or can't afford to hire a lawyer or whatEVER -- why is so hard to believe that those people might have a hard time getting their appointments and treatments and medications paid for?

Re: Health Care a Different Experience for the Privileged

kathykattenburg — Fri, 31 Jul 2009 21:15:01 -0000

And how does having a government single payer system increase freedom and competition?

In a single-payer system, if you need to see a doctor or if you have an emergency, you just walk into the doctor's office or the hospital ER, show them your card, and get taken care of. You don't have to worry about how to pay for it or whether your insurance policy will cover it. Freedom remains. Choice remains. The only thing that leaves is the worry of being saddled with mountains of medical debt.

Re: Health Care a Different Experience for the Privileged

roro80 — Fri, 31 Jul 2009 20:59:28 -0000

DrJ:
1. "why haven't their customers dried up?" As the post explains, most people don't really have much choice, and by the time they come up against this problem, they're already sick, which means other insurance companies won't take them.

2. "Why don't they do business this same way?" Generally speaking, they do. Not to everyone, not every time, only when they think they have a good strong case for getting away with it.

3. "Why haven't they shut health insurers down?" First: good question. Second: insurance companies have excellent lawyers.

"Are there any actual statistics on what fraction of claims insurers fraudulently deny?"
Ah, see, here's where those lawyers come in. They would object to your use of the word "fraudulently". Your "fraudulently" would be their "totally justafiably".

Re: Health Care a Different Experience for the Privileged

roro80 — Fri, 31 Jul 2009 20:51:13 -0000

"And how does having a government single payer system increase freedom and competition?"

Um... there are reasons such a system would increase "freedom" (whatever that is), but it certainly doesn't increase competition. It's not supposed to.

What I'm trying trying to figure out is how such a question, qwert, has to do with this post? I don't see anyone, within the context of this post, has said anything about single payer at all.

If you need a summary of this post, here's a quick-n-dirty stab at it, since maybe you forgot to read it: Person in WSJ says "my insurance is awesome, so everyone's insurance must be awesome, so don't change the system". Author of post says "well ain't that special that you've got great insurance, but in the real world down here on the ground, most Americans aren't quite so lucky; here's the evidence of that". Actually, instead of "lucky", the post uses the word "priviledged", which is indeed the perfect word.

Notice: no talk of single payer. What's the logical fallacy for making an argument against a point that isn't being argued?

Re: Health Care a Different Experience for the Privileged

Gootmud — Fri, 31 Jul 2009 20:43:23 -0000

JL, I don't know how we could forget that since the Michael Moorists are so handy with anecdotes about it, and no doubt it has actually happened.

But the claim that insurance companies habitually deny contractually-promised coverage has the ring of an urban legend: a scary story that imparts a strong moral but doesn't quite add up. Consider:

1. Established companies generally avoid fraud because they're concerned about their brand and reputation. If health insurers make a habit of cheating people, why haven't their customers dried up?

2. Other types of insurance companies have the same profit motive and face the same temptation to deny coverage after the fact. Why don't they do business this same way?

3. States have regulatory bodies that do nothing but oversee insurance companies and investigate claims of contract violation. Why haven't they shut health insurers down?

Are there any actual statistics on what fraction of claims insurers fraudulently deny?

Re: Health Care a Different Experience for the Privileged

Jim Bell — Fri, 31 Jul 2009 19:20:11 -0000

Let us not forget hat insurance companies do not make money by providing coverage; they make money by denying it. If there happens to be any health issue in Myrna's past that she has either forgotten about or didn't properly date the incident when she filled out the acceptance forms or history forms, there is always a full-time employee of every insurance company who's only job is to research patient histories until they find a reason to deny or revoke coverage. If they fail to find such a reason, they will resort to restricting total cost output toward any and every insured individual by capping the dollar amount of coverage available based upon the type of policy they are covered by (or almost covered by).

Re: Health Care a Different Experience for the Privileged

qwert321 — Fri, 31 Jul 2009 19:12:50 -0000

"Most people do not have freedom, but rather they have limited choices for their doctor and hospital."

And how does having a government single payer system increase freedom and competition?