Friday, February 19, 2016

My take on the healthcare problem.........

I decided to write another blog today after a family member posted that they went to pick up their prescription today and her out of pocket expense was $700. I know many may not agree but this is just my view point. 

I work in the insurance industry on the property and casualty side. I hold various licenses and have a lengthy educational background in insurance. I have worked in claims and on the agency side and enjoy making sure that people are covered in case a catastrophic event should occur. My first priority is to put my clients as close as I can back to the position they were in prior to their loss. I believe that some of corporate America is trying to dissolve the personal relationships agents have with their customers by combining all servicing into one central location. However we are still standing and I enjoy taking care of my clients. With that being said I feel like America has failed on health insurance and health care side. Although I am grateful for the amazing coverage and assistance Jude has received I can see a huge breakdown and something needs to be done. 

I would like to give you some examples. When Emily had pneumonia is 2015 I took her to the  medical center by our house. Luckily our visit was quick! The doctor was in the room for 10 minutes and she was diagnosed and orders were given for a breathing treatment and antibiotics. Yesterday I received a bill for the 20% co insurance that we would owe. I noticed the original amount billed to our insurance for the doctor (just the doctor) was $1353! That equates to $135.30 a minute for his services. Although I am grateful for his treatment I think this is in excess and I am challenging the bill. Another example of the level of issues we have is Jude's wheelchair. When a durable medical company visits your home to fit your child for a wheelchair you are eternally grateful they are there and don't want to complain in any fashion. Therefore it's taken me years to speak up about this. Jude's wheelchair is customized to fit him, non powered, and has a tray that is removable. It's a nice wheelchair but seeing that Jude has primary insurance and Medicaid we rarely see what's billed. So when I received a copy of the invoice in the mail the $12,000 price tag made me gasp. I understand medical equipment is not cheap but the sheer cost of these items are causing tremendous issues with state financials and the health insurance industry. I think if a cost analysis was done on the materials and the actual assembly of the chair the cost would be far less than the billed price tag. 

I remember when Jude was first diagnosed with his seizure disorder they labeled them infantile spasms. The first medication they suggested we put him on had a price tag of $25,000 a week and carried a 30% mortality rate. However they widely praise the medication and suggest if for children that have the chance at a normal life. I remember my cousin was sitting in the room with us when the doctor suggested told us about the medication. She blurted out "Good LORD what is it made out of 24 carat bald eagle sperm?". Excuse the crass comment but it was rather hilarious and even the doctor laughed. The doctor mentioned how over inflated price tags are put on highly coveted medications and explained it had bothered him for years. Doesn't something seem wrong with that? I also want to add that I know many health care workers are very underpaid which is baffling when we look at the invoices received. 

I have to admit that I am not well educated on the regulations and politics regarding hospitals, durable medical equipment, the pharmaceutical companies, and the health insurance industry. I do however think there is a huge problem in America that needs attention. Attention that also should include having better continuous care for our elderly and terminally ill without the hassle of constant appeals, denials, and harassment. From a consumers stand point I see the affordable health care act has it's positives such as adding maternity and providing care for those with pre-existing conditions. However, as a consumer I also first hand experience the health insurance companies response to the changes with constant denials and lengthy appeals. I see single mothers/fathers paying for insurance they cannot afford only to have something happen and they cannot afford the deductible set in place for the insurance they could actually pay for. So what's the point of having insurance if you cannot afford it and cannot afford the deductible? The regulated car insurance industry makes sure specific limits of liability are put in place for possible losses sustained. Everyone must carry at least the minimum limits of liability that coincide with research showing the average loss within their state. For instance Texas requires you carry at least 30,000 of bodily injury per person and up to $60,000 maximum then you must carry at least 25,000 of property damage. This insures if you hit another party and cause damage that the company will pay up to these amounts. You can increase these amounts to reduce the risk of a lawsuit in the event you cause damage. Liability is regulated by the state in regards to cost and is normally affordable unless you have infractions that increase the rate. 

So what is the answer? I really have no idea and this is why I am not in politics but I do believe the cost of medicines, medical equipment, and supplies need better regulation. I also believe the cost of hospital visits need better regulation. I believe we spend a lot in health care and most people (not us) see less for their dollars. I believe a lot of that is due to over inflation, waste, and improper billed amounts. I have caught our primary insurance deferring fees to Medicaid even though our plan was then paying 100% coverage. They fixed the issue and refunded the money to the state but I wonder how may times this happens. I have reached out to each possible presidential candidate to see their stance on the medical industry. I am involved on the political side regarding reaching out to representatives that could possibly help but it's a slow moving process. 

Again I don't know the solution but I do know there is a problem. 


Anonymous said...

On car insurance - 25K for car property damage is probably not enough. E.g. our state requires 50K and our agent mentioned that is probably not enough. He said this after our minivan was totalled in an accident where 5 cars were involved. The other car that was totalled was completely at fault. So multi-car accidents, if one hits a commercial truck or a building it can easily exceed 50K. Replacement on our van will be just about 27K, and then there are the rental charges on top of that. And it never really covers all the costs incurred by those damaged.

On insurance - not sure ACA is responsible for insurance companies denying more, think they would take any loophole or excuse they can. Dealing with insurance is Kafka-esque - think it is a curse humans inflict on ourselves. Last call with our health insurance company and I was trying to see if all the costs for the last surgery were there and the customer service person was obviously not used to seeing 41K in charges show up or be discussed so casually. That was for minor brain surgery of less than an hour and maybe includes the one night for observation. Imagine if it was something major. At least with ACA many out of pocket charges are capped (but not everything because ambulance rides might be private or non covered specialists). Our coverage is private and I'm glad there's a per-person out of pocket cap because I'm not sure there has to be one for private insurance and that's a scary thought. Our child is on the cheaper end of medically complex. Worrying about costs was not a problem when we lived in a single payer country for a few years. One could pay for private care but it couldn't be faster or better than the regular system when someone was sick. There was also less price gouging on the private side because there was a public system available so that is a major way I see costs can be contained. The buildings were less pretty, the care was great.


Anonymous said...

It's ironic that I read this post today. My SIL has been under workers comp due to a workplace injury for about 10+ years. She hurt her knee originally but due to the length of time w/c took, it messed her back up something fierce. She was scheduled to have surgery on Monday to have a prior procedure reversed and the surgeon was assuring her he could help her all the while knowing it was a w/c claim. The night before the surgery, he cancels the surgery because he wants 5x the money w/c is willing to pay. Since they will not agree to pay this, he will not move forward with the surgery. She cannot afford to pay it so she is stuck back at square one. I understand that sometimes insurance companies are jerks. (I too work in the insurance field) but to leave a woman who is in agonizing paid high and dry over money really stinks. W/C has told her that once she finds another surgeon, they will authorize immediately but we shall see. Maybe if the shoe was on the other foot, someone, somewhere would understand and there would be a change.

Valerie in NJ