Tornado Alley (PROG)

[loophole73]

Bulldzr, finally someone is attempting to expose the death spiral of health insurance in America.

Although I believe I have done a much better job in exposing the insurance sham over the last twenty years, at least this guy is trying. I have literally written most congressman, I never get an admission or even "thanks, I will look into it". I have even provided an example of same doctor, same surgery center, same anesthesiologist and exact same procedure used on me and my friend of over 50 years. My friend had insurance through his employment. His company was paying $800.00 per month for his premium and he had a $2000.00 deductible. I was self insured. I negotiated my price and received a $1500.00 drive out price. My friend's insurance company accepted a drive out price of $3500.00. Thus, my friend's company paid $9,600.00 to the insurance company for his annual premium. My friend paid $2000.00 (deductible amount) plus 20% of 1500 ($300.00) for a total of $2300.00. The insurance company paid $1200.00 for the incident, but there is more to the story my friend. This my favorite part. The PPO (another entity owned by the insurance company) charged my friend's company $600.00 under the PPO cost. Why and how you ask? It is called repricing. The doctor bills for his usual and customary fee which in this instance was $4000.00, but the PPO has an agreement with the doctor that they will only pay $2000.00 with an agreement that the doctor accepts same as payment in full and will not seek any more from the patient. You are now saying how can this be? Well I am not through with this story yet. The doctor has so many agreements with insurance groups that he does not have a balanced billing system in place. Thus, he has an inaccurate accounts receivable portfolio. He does not care because he is just grateful to finally get his $2000.00 after the insurance company has strung him out for a few months before paying his agreed price under the PPO. So along comes a couple of hucksters out of Arizona who tell the office administrator that will collect old receivables for a percentage. She gives them a portfolio and off they go. My friend gets a demand letter for $2000.00 for unpaid medical services. Patients do not know these repricing schemes exist and they pay these hucksters despite having no contractual obligation to the doctor.

This why I have been against Obamacare because it is simply reckless to throw folks into the insurance cesspool we have in this country. I stood up at a town hall 3 years ago when my representative was bragging about repealing Obamacare. I told my story and it was clear he could not grasp the situation. I asked him to give the people in the room a promise that if he was successful in the repeal, would he offer a bill in the House to mandate that the insurance companies rebate or credit to every insured the amount of premium charged over and above the premiums being charged the day before the passage of the ACA. He quickly said he could not make that promise. I said why not, the increases have been blamed on the act? He said we have more to cover today and brushed me off. I left to a standing ovation.

This insurance scam is a job killer. It has been going on far too long. There is no reason that health care pricing should be set by and between the deepest pockets in the world and the healthcare providers. This does not provide a true free market price. Further, the big insurance companies by the very definition of increasing shareholder value must show and report recurring and increasing revenue to the Street. The only way this can be done is to increase premiums. Further, It is obscene that insurance companies are allowed to carry their investments on the liability side of the ledger under the guise of reserves for claims. Everything in the industry based on a percentage of premiums including payments to brokers which creates a huge conflict of interest from the onset. The problem is those brown bags delivered every Friday around lunch to every person in Congress probably contain something other than sandwiches.

Every person should be entitled to catastrophic insurance based on ability to pay. Every person should have access to a doctor for checkups based on ability to pay. If pro bono is necessary, so be it. Every person or entity should question their brokers about what they receive for placing their insurance. They will be shocked at the initial number and the annual bonus they receive for placing their insurance. Nobody should get a better deal because they work for a company rather than being self employed. Insurance rates should be based on the claims statistics of the entire population rather than smaller groups. HMO, PPO and any other 3 initialed entities should be a thing of the past. All should be treated equally. People gripe about medicare, but at least the prices can be controlled under the plan. OK, I will get off my soap box now.

MO
loop