Posted by: guinness222 | August 25, 2018

The Healthcare Conundrum Part 2 – Insurance Companies!!

Please bear in mind, I am a writer,( or at least I try to be!) In the first segment of this article I dealt with “the DOCTOR”, the, sometimes unwitting collaborator rings us to the second collaborator, The Insurance Companies.

The Insurance company, with it’s hundreds and thousands, in some cases, of employees, actuarials, and most importantly LAWYERS, have the resources, the “two sided” rationale and , and most importantly, the MONEY, to sustain it’s existence longer than any Doctor, or Patient, except for the likes of Warren Buffet and Bill Gates.

Insurance companies exist, as every company in this country, to make a profit for it’s shareholders. Sure they have developed “sharing” relationships with BIGGER and more NOTED insurance companies to “lay-off their risk” in “sharing” it. With larger insurance companies, like Lloyds of London.

What does that mean to us? Simply put Insurance Companies are the Corporate form of “local bookies”!! You don’t believe me? Bookies “layoff” their bets, or risks, on what they insure, with the bigger “fish”. The bigger bookie can afford it,or has people above his humble business than can afford to “cover the “loss” on a 50 to 1 bet on the New England Patriots to win the Super Bowl, almost three months before the season even begins. That is what gambling and betting is all about,…the “risk/reward ration.

For example if the Patriots are facing off against the Green Bay Packers in the SuperBowl, it is logical for Patriot fans to bet on them, and Green Bay fans to bet on the Packers,….that’s a fact! BOTH CAN NOT WIN!! Therefore some folks will win big, others lose big. That’s where the odds come in to play, and the farther out from the actual gain the more can be made, if you win the bet!

Bookmaking SHOULD be LEGAL just to level the playing field. While the “bookies” are illegal, they play an important role. They actually insure a more level playing field so the Boston Fans don’t put their local bookie out of business, because he will “layoff”, or sell some of his bets on Boston off to out of state bookies for a lesser amount which allow him to come up with the payout money without going broke! And because the “bookie” to whom he “laid the bet off on”, can now cash in a winner on his own if he had not laid off a portion of his own bets on the Patriots. Confusing, but it is a situation that’s been around for centuries, and truthfully you will never meet a poor bookie, because if they are not paying attention to their business, they go broke really quickly.

Insurance companies are the “bookies” of the Medical profession. The “backfill” the costs or losses a hospital may incur by passing the loss off on it’s premiums to it’s policyholder. Sound “noble, right, and a fair system, but no enter the Healthcare Administrators at the hospital. How so you ask? By inflating the hell out of the “costs” of providing the actual services they provide!

The little box of Kleenex, and handy disposable pitcher of water and the other, “extras” that are tacked on your bill, not to mention the costs of cleaning the hospital, it’s equipment, and what the hospital purchases to operate. Is the cable services in your room for the TV or the Internet access you get, who pays for that? Just think about it and with all the “Volunteers” working at a hospital that reduces the “paying jobs” yet they are not providing the services for remuneration, but IF THEY WEREN’T the Hospital would have to hire someone to do the job, yet where does the profit made from these things go??

Besides that, have you ever seen a Hospital file bankruptcy? And if you don’t pay them because you have no “insurance” the bill simply becomes a “Tax write-off” for them. It balances the overcharged prices that they bill the Insurance Companies, who by the way have already colluded to accept lower amounts and padded them up so that their losses are HUGE, (on paper). Do you really think they lose sleep over it?

About a year ago I had a Hip issue (between the pelvis and the leg bone) , my Primary Physician refers me to an orthopedic Doctor, he does two X-rays and tells me it is pain in my “Lumbar area”, and further in less than 15 Minutes, refers me to his “colleague”, in time for the entire two more X-rays, and he’s wanting to send me for an MRI (Magnetic Resonance Image) so he can determine EXACTLY where to inject Cortisone Steroids into my spine???? Hello, SPINE!!!, Granted he may be a “good” doctor, but I’m not willing to gamble “paralysis”, and loss of movement from my waist down as a side effect of a misjudgment, or a “oops!”, particularly after only four X-rays, and NO ALTERNTIVES!!! I don’t look good in a wheel chair or walker!

So I ask if there is an alternative, the answer is that we can try a “Brace” which will help, but not cure the problem. I opt for the brace, (after all they tell me Medicare will pay for it!) I get my “Girdle”, or brace, try it according to directions (20 minutes a day, every day) it really doesn’t help BUT at the end of the month I get my Medicare Part “B” statement, and guess what? They refused to pay the Doctor’s for the Brace, BUT also told me I wasn’t liable to pay for it because the Doctor’s office was not authorized to sell it and be reimbursed by Medicare!

At my next “follow up appointment”, I mentioned this to the Dr., gave him copies of the notice that I was not liable for it! Guess what, I never heard from them again, the Brace is in it’s original plastic bag by my bed on the floor. (By the way they billed Medicare over $795, for this “girdle device”.

I am concluding that, based on my third or fourth Chevrolet vehicle, it’s the fact that the driver’s seat is slightly “offset” from the steering wheel so when you get behind the wheel, you are offsetting your upper and lower body to accommodate and let you drive over time.

Until I find some ambulance chasers willing to do a “class action suit” against GM and verify it,……here I am!!

Part three is simply a “rant”as to why we are overall screwed up when it comes to health care. Do not misunderstand me, I would go to work tomorrow for the Insurance Industry to TRY and control costs and fraudulent practices and basic reasons the costs all are moving “faster than a speeding bullet”, to put everyone at risk! There has to be a solution or we and our government all go down together


August 26, 2018

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