Archive for the 'Insurance Issues' Category

Government Run Health Care

Published
by
Dr. Edward Gould
on November 15, 2009
in Cincinnati Chiropractors and Insurance Issues
. 0 Comments

uncle sam

Let the buyer beware

Currently our government is in a mad rush to revolutionize the health care system in the United States.  As a physician, I agree that something needs to be done.  However, after listening to the current administration’s grandiose planning,  I’m left feeling uneasy and concerned.

I have been in practice since 1988. In that time period, I have witnessed a continual rise in deductibles with a simultaneous reduction in allowed services.  During this same time frame, my patients tell me that their premiums have gone through the roof.  Yes, policyholders are paying more and getting less. This appears to be the model of change in the insurance industry since the creation of HMO’s.

Health Maintenance Organizations

hmo-contractPromises… Promises… Promises… I remember when HMO’s were being advertised to the public and to physicians, as the next best thing since sliced bread.  The so called experts were touting all the “amazing benefits” that would come from people joining HMO’s.  Well, what has transpired since then has been quite a different story.

By far, the majority of people that have HMO’s are not happy with them.  Physicians that got hoodwinked into joining them are tearing up their contracts; they’re tired of being over-burdened with redundant paperwork, having bureaucrats defining their treatment protocols and having their fees cut by 50% or more.

Unfortunately… Common sense is not so common

Here is my concern, the people that are in charge of changing our health care system, don’t even understand it. If you don’t understand it, how can you possibly fix it?

The Government Health Care Plan will use HMO’s as their template.  Imagine a marriage between an HMO and Medicare, and then add layers-and-layers of Governmental Bureaucracy.

Put on your running shoes, the information age is chasing you.  The government wants all patient records to be available via Electronic Health Records.   By doing this, massive data bases will be created.  Data mining will allow diseases and syndromes to be pigeonholed and quantified.  On the surface, this sounds like a great idea; however this information will create a double edged sword. On the plus side it will give researchers and physicians a better understanding of diseases. On the minus side, both treatments and cost allowances will ultimately be determined by these numbers.  This will ultimately lead to denials of care, if you or your loved one’s disease requires care that is outside the allowed calculated amount or time frame.

Herein lies the rub,  physically, physiologically and psychologically we are all different.  When treating someone’s disease or illness you quickly find that there are many variables that will impact the patient’s outcome.  Many of these variables are beyond both the patient and the doctor’s control.  We all know of two people that have had the same disease yet had totally different outcomes. This is a reality that on many occasions is unquantifiable.

I’m all for minimizing costs and maximizing outcomes, however, until we all have identical genes, eat the same foods, live in the same environment, think the same thoughts and get the same amount of physical activity this will-never-happen. It is simply not based in Reality!  I don’t care who writes the bill be it a Republican or Democrat.

Personal Responsibility

Helping HandOur government’s responsibility is to give us a helping hand, not a handout.  Personal responsibility has almost become an oxymoron in our country.  This is a sad fact, because that trait alone can not only change one’s life but also can transform a country.  Without it, both the individual and the country are destined to mediocrity.

Our dysfunctional government makes an easy target for our criticisms; however, we must begin to look at ourselves.  Especially when it comes to our health, irrefutably the most important possession we have.

Are you doing all you can do to be as healthy as possible? A few questions:  Do you smoke? Do you drink?  Do you eat a healthy diet? Are you overweight? Do you get regular exercise? Do you regularly wear your safety belt? The answers to these questions dramatically impact your health.

The Bottom Line

Change is on its way.  If the Government’s Health Care Plan goes through and personal responsibility in our country does not increase, we will only have ourselves to blame when the system collapses.   It’s time we turn our shoulds into musts!

Becoming healthier is a journey.  Begin your journey today!

Yours in Health,

Dr. Gould

Insurance Choices Get the Facts!

Published
by
Dr. Edward Gould
on September 10, 2008
in Insurance Issues
. 0 Comments

hmo-contract.bmpLet the Buyer Beware?

I have been practicing Chiropractic since 1988. Since then, the complexity of insurance plans and the shrewdness of their policy writers has reached an all time high. In this post, I’d like to raise your awareness and maybe even rant a little… so that when your policy is up for renewal or if you are self employed and are currently looking for coverage you will be better prepared when confronted by an insurance salesman. If you currently have insurance pull your card out and try to read it. Look how much white space is available, yet look at how small the print is. Most people have to get a magnifying glass to read it. Subtle isn’t it? Maybe a bit confusing. I told you they were shrewd. As soon as you contemplate using it, they even make the first step of the process difficult.

In My Opinion

There is a health care crisis in this country. Many people have no coverage. This is a sad fact. What is interesting however, the people that do have coverage are paying more and getting less. Did you know that insurance companies spend more money on administering claims than paying on claims? Did you know since the introduction of HMO’s doctor’s fees have continually been cut. Not that you the consumer cares about that fact. For a moment however, I’d like you to imagine your income being cut by 60%. Seriously, how would that make you feel? Even in non HMO plans, doctor’s fees have been cut. I never did get into HMO’s, I always thought it was a bad idea. Turns out it was a bad idea… unless of course you happen to be a CEO of an HMO, then you made multi-million dollar bonuses. All that extra money from denying claims has to go somewhere.

Dramatic Changes Ahead

In the not too distant future, both doctors & hospitals will begin to stand up and simply refuse to be manipulated by insurance companies. Over the past 10 years insurance companies have done their best to ruin patient care and force many doctors and hospitals out of business. Health Maintenance Organizations have been a sad joke for most people. The only true beneficiaries have been the insurance companies.

I’m often asked by my patients which Insurance Company should they choose? That is a tough question. However, I do give them tips.

  1. Always read the small print.
  2. Don’t expect the salesman to tell you everything. They Never Do!
  3. Create a hypothetical for the salesman… take notes of his/her answer.
  4. Understand Usual & Customary Fees (a fee that is charged for a certain procedure). This fee use to be the same for a certain demographic. Many insurance companies create their own fee system now. In some instances they pay less than 40% of the fee. Leaving you to pay the rest. Of course they will tell you you can appeal. (I think in many cases they tell you this to appease you… knowing full well they will not change their decision.)
  5. A few insurance companies love to say your care was not necessary… You know, Medically Not Necessary! Get on the internet and Google all the companies that you are considering, for complaints. It will be an eye-opener for you. You will quickly note some companies are worse than others. Make sure you check for your city and state.
  6. Does the company use a third party administrator to evaluate claims? If so, stay away from that company. In fact, run from that company.
  7. The most troublesome company I have had to deal with in the past couple of years is HUMANA aka (HEALTHWAYS). I could write an entire book on this company.

Below is an Eye-Opening Informational Briefing at the California State Legislature.

 

I hope this post has been helpful. If you would like to comment on the above please do so.

Yours in Health,

Dr. Gould