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Monday, August 31, 2009
News Insurance companies ration care
Posted By Rhiannon Fionn-Bowman on Mon, Aug 31, 2009 at 1:25 PM
The spin phrase an insurance industry executive used in a recent New York Times article is "controlling utilization."
The article, ultimately, was about the insurance industry's workers licking their wounds after bearing the brunt of what they feel are unfair attacks by health care reform advocates.
So, I'll ask you to do this: The next time you pay $1,000 for a test your doctor ordered -- on top of the thousands you and your employer already pay in premiums each year; the next time your pharmacy tells you the insurance company won't pay for a full prescription (oh, and that'll be $150); the next time you receive a bill from your doctor's office when you though your bill was covered ...
Go easy on the sweet innocents at the insurance company. They're just trying to protect their triple didget profits so their CEO can get that jet he's been lusting after and so the company's shareholders will stay off their back.
In fact, the next time you get the urge to strangle your insurance agent, why don't you send them a huge bouquet of flowers and thank them for this year's premium increase. 'Cuz, without the policy they so lovingly sold you, you probably wouldn't have even agreed to have that test -- the one that saved your life and made your premiums jump even higher -- any damn way.
“I believe we’re getting the pushback because we are standing up for what we believe in,” said Cheryl Tidwell, 45, Humana’s director of commercial sales training. “We believe there’s a better way to control costs by controlling utilization and getting people involved in their health care.”Some workers said that unlike other contributors to the country’s health care problems — the doctors who overprescribe, the hospitals that fail to control infection, the consumers who do not take care of themselves — insurance companies are faceless, impersonal and distant.
They do not save lives. They just pay the bills. When they have reason to interact with patients, it is usually because something has gone wrong. “You’re not having a good day when you’re talking to us, unfortunately,” Mr. Shireman said.
Lisa A. Toombs, 40, a technology project manager and mother of three, said she had been taken aback by the attacks. “The way I see it,” she said, “the people who work for the insurance companies are average people. We’re not crazy lunatics running around trying to get at people.”
Such assertions may paper over the industry’s record of double-digit price increases, medical underwriting to exclude applicants from coverage, cancellation of policies for incidental causes, denials of claims, deceptive marketing and generous executive compensation.
Listen to Nathan Wilkes story. His infant son's health issues caused his company's insurance premiums to rise so high that everyone in the company is suffering and his son's medical treatment is about to exceed his policy's lifetime million dollar cap.
Further reading, from The New York Times: Until Medical Biills Do Us Part:
... peel away the emotions and fearmongering, and in fact it is the existing system that unnecessarily takes lives and breaks apart families.My friend M. — you’ll understand in a moment why she’s terrified of my using her name — had to make a searing decision a year ago. She was married to a sweet, gentle man whom she loved, but who had become increasingly absent-minded. Finally, he was diagnosed with early-onset dementia.
Eventually, after the expenses whittled away their combined assets, her husband could go on Medicaid — but by then their children’s nest egg would be gone, along with her 401(k) plan. She would face a bleak retirement with neither her husband nor her savings.
A complicating factor was that this was a second marriage. M.’s first husband had died, leaving an inheritance that he had intended for their children. She and her second husband had a prenuptial agreement, but that would not protect her assets from his medical expenses.
The hospital told M. not to waste time in dissolving the marriage. For five years after any divorce, her assets could be seized — precisely because the government knows that people sometimes divorce husbands or wives to escape their medical bills.
“How could I divorce him? I loved him,” she told me.
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