Posts Tagged ‘denied claims’

I Found It

August 23, 2009

I think I’ve found the exact moment in history when health care insurance went down the drain. When Sir Ted started his HMO’s they covered all the normal things like check-ups and routine tests but they were terrible for real problems, even simple ones like a broken bone. You had to truck all the way to your approved clinic or risk being hit with “unauthorized charges”.

Well, regular health care held it’s own for a while but all the healthy people started defecting to an HMO for the preventive maintenance. They churned out one routine test and check-up after another. Trying to take care of all the chronic illness and poor health cases hurt the health care insurance companies so they began to offer the doctor visits and drug coverage and all of the extras you see now to lure the healthy ones back. It was the beginning of health care spiraling out of control.

As services increased, costs increased, pay outs to doctors were more closely scrutinized and claims were denied. The doctors retaliated with inflated costs to cover denied claims. The game went back and forth until we arrived where we are now. A thirty dollar aspirin, a fifteen dollar band-aid and pad the claim any way possible in hopes that you’ll get what’s due to you. With anything out of the ordinary being denied by the insurance company without ironclad documentation, it’s to the point now where most health care facilities have become “mills” churning out assembly line like treatment with most of them specialized to decrease the chances of misdiagnosis.

How do we fix it? What, do you think I’m Socrates? Can we go back to the way it was? Are you willing to give a little. Will the doctors give a little. Will the insurance companies give a little. If anyone says no, we are hosed. The illustrious leader has proclaimed that it’s unsustainable, and I hate to, but I’m afraid I actually agree with him. Excuse me while I vomit.

Health Care

May 21, 2009

When health insurance was created it was for catastrophes. If you broke your leg it would take care of it, if you had a heart attack it would take care of it. If you had a cold you paid the doctor. If you had a baby you paid the doctor. It worked very well and health care was affordable.

When things didn’t happen to people they thought the insurance company owed them something, even though they had peace of mind for fifty years, they felt that the evil insurance company had somehow ripped them off. They demanded more of a return for their payments. The insurance companies responded, for a few dollars more a month you could get full coverage, doctor visits and babies birthed.

People ate it up, but the demand was high. Prices went up. Insurance companies began to bargain with doctors. They denied claims. The doctors countered, aspirin became three, four and five dollars each. A simple bandage, twelve dollars. If the insurance company caught it they argued, if not it was paid. Finally, the insurance companies came out with health care companies. Everything covered in one stop. Fine if you always stayed near the clinic. But if you got out of the area we were back to the denied claims and twelve dollar bandaids.

K.I.S.S. Keep it simple stupid. I’m a big fan of this. Back when you just paid for your health care it worked. Should we maybe just go back there?