Health & Wellness / Politics

Coverage That Doesn’t

coverageWhat’s the point in paying for health insurance when you still get the bill for medical care? You’re paying twice. Once for the coverage that doesn’t — and then, a second time, for the care you thought insurance would cover. But didn’t.

It’s a nasty surprise — and it isn’t uncommon.

These surprise medical bills most often arrive in the wake of an unexpected emergency room visit when there’s no time to determine whether an ER physician or even the hospital you’re taken to  is an “in-network provider”…  insurance industry legalese used to avoid paying for care the “covered” thought they’d already paid.

Which they were forced to pay for… by the government. Which decreed, via the Affordable Care Act, that every American has an obligation to buy health insurance but did not impose a requirement that insurance companies must pay for medical care.

This doubles-down on the effrontery.

People are compelled by the government to buy insurance many can barely afford -—  “coverage” that gets more expensive all the time precisely because the government forces people to buy it. CNB reports that the average cost of coverage for a family will increase by an additional 5 percent to an astounding $15,375 by the end of this year.

And then people get hit with medical bills they can’t afford to pay because they were forced to buy “coverage” that didn’t.

Meanwhile, the profits of the insurance industry soar. Anthem, Humana, United Health and Aetna all raked in billions last year — much of that by denying coverage using the shuck-and-jive routine of claiming that the “provider” was “out of network.”

The problem — an arguably engineered one — is that it can be difficult to determine which “providers” are “in network.”

Under the ACA, the insurance industry gerrymanders coverage areas. The “provider” closest to the patient might not be “in network.” Or one of the “providers” within a practice that is “in network” isn’t in the network.

You thought you were “covered…  until you get the bill.

In Virginia, where surprise medical bills have become a very public scandal, Judge Mark Christie — who sits on the state’s Corporation Commission, told the story of a man who called in advance to make sure the hospital where his wife was scheduled for surgery was “in network” and that the “providers” — the surgeon and anesthesiologist — were as well. He was told they were.

He was not told about the “hospitalist” who attended the procedure — whose services weren’t.

“How would he even know to ask?” said Christie, who favors a requirement that patients be notified in advance if they are to be treated by an “out of network provider.”

Hospitals oppose this because of the paperwork onus it would impose on them, increasing their costs. Insurance companies oppose it for the obvious reason that it would be harder for them to deny coverage to the “covered,” decreasing their profits.

The system is almost purposely perplex — and tragic, because many of the people who get caught up in it were in need of urgent care at the time the bear trap snapped shut on them.

It is not uncommon for people to be bankrupted by these surprise medical bills.

Naturally, the solution favored by the insurance companies is to double-down on the problem — by forcing everyone to pay higher prices for less coverage — via price controls.

This, of course, is not the term used, for the same reason that Social Security taxes are called “contributions.”

Thus, “benchmarking,” which would establish price controls based on “average prices for services in a given geographical area”… those “average prices” to be set by the government, in cahoots with the insurance industry.

Instead of competitive plans that offer a degree of choice and thus introduce a degree of market discipline into a system that badly needs exactly that — the insurance industry wants a one-size-fits-all “plan” (fixed prices) —  for all that no one can say no to.

This would have the advantage — from the point of view of the insurance industry — of increasing what people can be forced to pay for coverage while decreasing what the insurance companies pay for care. Doctors and hospitals would be forced to accept whatever the insurance companies consider “fair” payment for their services.

The only option left to doctors and hospitals would be to limit the care they provide — or work for whatever the insurance industry says their services are worth. You can probably guess which option most doctors and hospitals will choose.

Two congressional committees, Ways and Means and Education and Labor, are debating stopgap solutions, including an arbitration requirement that would provide a degree of potential relief from surprise medical bills.

But the real solution to this problem would be to restore the power of Americans to say no to coverage that doesn’t by getting rid of the mandate that they buy it. They’d be free to buy coverage that does, which would cost them less and give them more choices for exactly the same reason that a cup of coffee at Starbucks doesn’t cost $10.

Because Starbucks can’t force them to pay $10 for a cup of coffee, or send them a bill for coffee they didn’t even get to drink.

Reprinted with Permission from - Inside Sources by - Eric Peters

If You Enjoy Articles Like This - Subscribe to the AMAC Daily Newsletter!

Sign Up Today
Read more articles by Outside Contributor

Leave a Reply

  Subscribe  
Notify of