10 Reasons NOT To Choose A Particular Health Insurance Plan

1. The company has a ‘good’ name or is recommended by your doctor.  Many doctors give the ‘thumbs up’ for an insurance company only because they have a currently favorable financial reimbursement arrangement and contract.   Insurance companies fall in and out of their ‘favored’ list based upon their reimbursement arrangement and nothing to do with the integrity of the insurance plan itself.

2. The plan offers coverage for initial expenditures but there is a ‘cap’ or limitation on how much money they will ‘shell out’ in a given year or over the lifetime of the plan.   This can be problematic in pharmacy coverage.  $2,000 per year might be ample for most people in most years but what happens if  you end up with Multiple-Sclerosis or Parkinson’s Disease or a form of cancer that can only be treated by very expensive drug treatment.   Costs in these cases can run $12,000 per month or more.

3. The plan has an ‘association’ benefit to it, providing you with ‘tremendous’ discounts on pharmacy, health related products, etc.  In reality the outcome is that you end up on  mailing lists.  This is not insurance.  I found that simple membership in “Triple A” or AARP provides better benefits.

4. The company or its agent is always referring to the maximum deductible you would incur without mentioning that there is ‘co-insurance’ or a sharing agreement after the deductible.  I’ve seen some of these extending a patient’s cost liability an additional $10,000.

5. The insurance company has a reimbursement  arrangement only with  particular laboratories or testing companies.

6. There is a separate deductible for medical ‘events’ with the deductible applying to each medical “occurrence” versus an annual deductible where all expenses are added to meet your deductible.

7. This one really bothers me—you take your kid to the emergency room for an injury and instead of paying a copay covering everything, they charge you a ton of money since your deductible has yet to be met.

8. The insurance company is an HMO or still functions as if it is one.  This would imply a limited network of ‘providers’ (i.e. doctors, hospitals, etc.) and restrictions as to whom you can see.     

9. The fine print of many insurance policies read that the insurance company must be consulted prior to your doctor or hospital initiating anything beyond emergency procedures.   The problem that arises here is that there is a difference between a hospital telling the insurance company what it will be doing and a hospital asking permission to do something that they highly recommend.  Make sure the choice of procedures is in your hands!

10. A POS plan (point of service) or ‘Traditional’ health plan provides welcomed out of network availability.  The insurance company typically offers a sizeable discount to your sticking in network.  Make sure you calculate what your total financial exposure could be if your life dependend on going to the Mayo Clinic or a major cancer center.

                                         “Health Care” for all!   “I demand my ‘health-care” “I want my MD”!

 Before a problem can be solved it would seem to be of paramount importance to define exactly what the problem is.  Not a day goes by without having someone complain ‘what about my health care’ or demanding some form of vaguely worded need  that their ‘health’ be taken care of.

  Are we using ‘health care’ to include free access to everything medical or health related from band-aids to cancer drugs to lab work to brain surgery to chiropractic to dentistry?    How do those people who are involved in  working in these fields expect to be compensated if the ‘users’ are asking the ‘providers’ to make what they do available to the user without cost? 

Maybe the ‘users’ are really saying that someone else should provide for the payment of these ‘health care’ goods and services?  Now if the ‘users’ are either unable or are unwilling to pay what the ‘providers’ demand then sounds like it’s a good time to get someone else to pay for these things for us!

Hmmm let’s see.  There are ‘health insurance’ companies which somehow allow people to pay  something each month and in turn they’ll pay for our ‘health care’ which we so desperately need or want at least.  But why would these companies whose mandate is to make money for their owners or involve themselves in an arrangement like this unless they thought they would benefit?.  Likewise, those people who ‘need’ or ‘use’ health care would seem to be the people who would enter into an arrangement like this since their health insurance expenses are much less than the amount of money the ‘health insurance company’ wants me to pay.  Also if I’m healthy most of the time does it make sense for me to pay the same amount for health insurance as those people who are frequent and expense users of ‘health care’?   It would appear that under these circumstances why would any profit seeking enterprise involve itself in this

Well, if we cannot convince companies to enter into these relationships due to their lack of profitiablity then that leaves us with the US Government or the ‘taxpayer’ really.  How much do you think it would cost for the US Government to pay for any and all of these expenses for the people who only ‘want their healthcare’?   And would the government pay whatever amount the ‘provider’ wanted and says he/she is due?  Or would the government demand that providers are only reimbursed for a certain dollar amount for a certain procedure?   What quality class of ‘providers’ would accept this kind of payment?  Perhaps the ‘providers’ would have to triage all their patients and serve only a minimal number of patients or perform a minimal number of procedures?