Wednesday
What You Should Know About the Health Insurance Industry
Ever wonder why you have to pay a co-pay to see a doctor on top of your monthly premium?
It's because the insurance companies want you to only go to the doctor when you really need to - they are a business, and they want to make as profit as possible. Since some people would abuse going for doctor visit if they had no vested interest, the co-pay works as sort of a deterrent.
Ever wonder why you received a bill saying you owe a doctor money?
First you need to know that most insurance companies make deals with doctors to pay a reduced amount for services in exchange for allowing a doctor to be on a plan. For instance, an initial doctors visit would cost a person $100.00 if they paid for it themselves. The insurance company may have a deal to only pay 80%. So, they give the doctor $60.00 and you give the doctor a $20.00 co-pay to total the $80 in the agreement.
Here's the crumby part... Sometimes you end up with that $60.00 bill because your insurance company doesn't pay anything. They may refuse to pay because you signed up for insurance as John S. Doe and doctor submits your bill as John Doe - because you left off your middle initial of the doctor's paperwork - even though your address and birth date and social security numbers are all identical. What if you change addresses and don't inform the insurance company? They do not pay. Maybe the computer that accepts bills for the insurance company just kicked out your submission. Sometimes it requires 2 or 3 or 8 submissions to get any payment from the insurance companies. Sometimes - as a mater of fact - on average about 50% of the time they pay nothing. Sometimes your co-pay is all the doctor ever receives. Once the doctor wastes enough time on an claim that's only worth 80% of their regular fee dealing with your insurance company, they send you a bill. Sometimes it seems to be the insurance companies spend so much time and effort trying not to pay a claim, they could more cost effectively just pay the claim - not true. As proof, look at the insurance industry profit margin compared to other businesses - pay attention to how much many they have to spend on advertising. They make money hand over fist.
Ever wonder why you have to wait for the doctor even if you arrive on time?
Partially due to the insurance companies... partially due to that person before you. In order to stay somewhat profitable, doctors have to compete for insurance company business. They schedule people sometimes in 15 minute intervals (since that is what the insurance company deems a correct amount of time to see a patient for a normal visit). Hardly any doctor can diagnose a patient in 15 minutes - unless the doctor just interrogates a patient and only allows them to answer questions that are asked. Some people like to talk, some are scared to death of doctor (like me). How quickly a doctor can find out what's wrong with someone depends upon the person.
Joe_Sutphin
