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Let 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.

Call today… 513-791-8110

Yours in Health,

Dr. Gould