Health Insurance Companies and the Ethics of Health Care…You Ain’t Gonna Believe This!

November 26, 2013

Some may know – especially those who have been following my most recent blogs related to a return of Prostate Cancer that I’ve been dealing with – but today was a Red Letter day when it comes to Health Insurance, Health Insurance Companies and how they ethically (oops unethically) deal with their customers.  I am not sure how we got here, but where we are when it comes to our health and how that is paid for is so broken it’s quite unbelievable.

WHAT’S THE SCOOP?

healthcareToday was a follow up visit with my local doctor.  Nothing special and almost a waste of time, but the appointment was scheduled and kept.  Routine visit – weight, blood pressure, temperature, and nothing unusual.  Today I was to receive the results of my bone scan and CT scan, but since I got a CD with the data ready to send to the Mayo Clinic (which of course I read – not that I’m a doctor, but I can read, and a report that says nothing was found was exactly what I was expecting), which I sent, I knew the outcome before the visit.

Doctor enters the room with a pleasant smile asking me how I am.  Now that was a loaded question since I am full of frustration over the way Health Insurance companies deal with their customers (namely me).  Of course since I am the one that wants treatment, I personalize their actions.  Yes, I know better, but to me it is personal since it is my health.  So…I proceed to vent to the doctor.

“Doc, I don’t know how you deal with these insurance companies day in and day out!  They are a pain in the ass.”

“You don’t know the half of it,” he responded, “and it’s only getting worse!”

For a few minutes he openly allowed me to vent, then looked at me, removing his glasses and said, “Let me vent a bit.”

AMAZING STORY!

Of course with no identifying information shared, my doctor shared with me the most amazing story I’ve heard (and I suspect that this is nothing in comparison to many many more stories like this out there).

“So I have a patient with advanced lung cancer.  He’s been a smoker most of his life, so as you can imagine his lungs are pretty damaged.  Likewise, he has cancerous lymph nodes in his chest.  So I suggested a form of radiation treatment that is more localized to his tumor so that I can spare what little lung he has left.  If I use traditional radiation the tissue damage will create substantial problems for this man who needs to salvage as much of his lung as possible.

I submitted my request to his health insurance company.  Their reply:  DENIED.  They wanted me to use the conventional treatment!

I told the person on the phone, because by now I was personally involved, that if it were their lung or even their father in a similar situation, they would want the better treatment.  The treatment that would salvage what lung he has left.

They then suggested that I resubmit the request showing the two treatments: (1) more effective treatment and (2) conventional tissue destroying treatment.  We did that.

Got the response today:  DENIED!

I was incensed and called again for a peer to peer discussion.  Not more than 30 minutes ago I was told that the conventional treatment was all that was needed, even though I know that the damage from that will substantially diminish his quality of life and could create more medical costs down the road.

Chuck, they just don’t care!”

HOW DID WE GET HERE?

How did we get to the point that a person checking off a checklist is the determining factor into the kind of health care we receive in the United States of American?  Are we really OK with care provided at the lowest common denominator?  We we can receive quality treatment but the insurance company will only pay for adequate treatment, is that OK?

SHARE YOUR STORY

You don’t have to name names, but feel free to share your story.  Maybe if enough of us get our stories told…SOMEONE WILL LISTEN.

FEEL FREE TO SHARE YOUR STORY OR YOUR COMMENTS.


MediGap Advisors fills Need for Seniors

December 10, 2012

Last Friday I was featured as a guest on a nationally syndicated talk show where we discussed Social Security, Medicare and the fiscal cliff.  No doubt the US faces challenges today when it comes to social welfare programs and individuals face a variety of challenges when figuring out what to do to solve their individual health care issues.

MedigapBelow is an interview I had with a leading provider of Medigap coverage.  Perhaps this will help…

  • Define for my audience what you do and how they will benefit from contacting you?

We help individuals who are on or about to qualify for Medicare choose among the many options for insuring their health.  We offer instant quotes and information on Medicare supplement, Medicare Advantage, and Part D prescription drug plans.  We show them how to save money on their healthcare expenses, and how to get the most from Medicare.

  • If someone were to visit your website, what would they come away with that provide them value?

Everything they want to know about Medicare, Medicare supplement, and Part D prescription drug plans.  They can get instant quotes on plans, details on coverage available in their area, and information on when the open enrollment period are.

  • Share a bit of your background and help my readers know at a deeper level who you are…

I am president of Medigap Advisors.  I have been helping individuals get the best value in health insurance for over 25 years. I believe in free-market consumer-driven healthcare solutions including HSAs and HRAs, and greater healthcare price transparency.  In my blogs and other writings I share strategies for lowering healthcare and health insurance costs, ideas for improving our healthcare system, and techniques and lifestyle strategies for optimizing personal health.  I was also founder and publisher of The Paleo Diet Newsletter, and like to show people how they can avoid medical expenses in the first place through lifestyle changes.

  • The fiscal cliff gets a lot of press – how do you see your product’s potential moving into 2013?

Medicare is a government program that has a major impact on our society, and enables seniors to live in dignity, as many experience increasing health problems as they age.  However, the program is not financially stable, and government efforts to control costs are leading to doctor shortages and increased costs for Medicare beneficiaries.  We keep our clients informed on ways to protect themselves from the risks that healthcare costs impose, and how to make the most of their Medicare.

  • From a business perspective, what do you see are the three most pressing issues that businesses face in 2013?
  1. Obamacare may reduce options for Medicare beneficiaries if funding is cut for Medicare Advantage plans.  These plans provide Medicare coverage through private companies.  Unlike original Medicare, Medicare Advantage plans have a maximum out-of-pocket which limits how much someone may have to pay for their medical care.

  2. The baby boomers are retiring, with 10,000 per day turning 65.  This is going to place increasing burdens on our healthcare system, with doctor shortages likely.

  3. Growing government debt and the retirement of the baby boomers will continue to put serious strains on our nation’s economy.  Growth in inflation will impact those on a fixed income harder than others.

  • If you were to define the two most important services you offer, what would they be and how do you help you clients with them?

1)    We help people compare the health insurance options available to them, and help them find the plan that offers the best value.

2)    We then do our Annual Comprehensive Policy Review each year to make sure they continue to stay with the plan that offers the best value, as premiums and needs change.

3)    We show people additional ways to protect their financial situation through long-term care insurance and other financial products.

  • There are many providers of Supplemental coverage for Seniors – why you?

We are brokers, which means we can shop the market among the various insurance carriers, and help our clients find the best value for them.  We make the process easy – instant quotes are available on our websites, and helpful advisors can answer questions and help our visitors compare plans.  Everything is handled over the phone and via email – no salesperson will ever come to your house or place of business.

  • Assume this last question is directed to media – what one thing would you want media to know about you and your services that you feel would make a difference?

10,000 Americans are turning 65 every single day, and deciding how to insure yourself in retirement can be a confusing and complicated process.  Because you may only get one chance at open enrollment, understanding the difference between a Medicare Advantage and a Medicare supplement plan and which is right for you is critical.  We help our clients cut through the confusion, and we make the process easy.  All the information is on our website, friendly advisors are available to help, and no salesperson will ever come to your home or business.

For more information about Medigapadvisors visit here:  http://www.medigapadvisors.com/