What will they cover? Not a whole hell of a lot.
Yesterday I went to my dermatologist. Nothing serious, an annoying skin problem. When I walked in the front door to tell the receptionist who I was, she didn't say hello, she handed me a sheet of paper. Printed on the paper was a long list of skin conditions and treatments which were no longer routinely covered by most insurance companies.
What I received was a polite notification that if I needed any of these procedures, I would pay out of pocket and I would fight the insurance company for reimbursement. This sort of defacto denial is routine for desperately ill cancer patients denied expensive life saving chemotherapy. But it's making its way into every facet of healthcare, right into your doctor's waiting room.
Just the other day, a Kossack wrote:
Colon cancer is almost entirely preventable
(if one gets a periodic colonoscopy which not only detects the pre-cancerous polyps but also removes them, as part of the procedure. I don't know the details of Snow's colon cancer, whether he had or hadn't had colonoscopies prior to diagnosis. But I do know that everyone should get colonoscopies so that almost no one would get colon cancer.
So why is it that Blue Cross of PA refused to pay for my first colonoscopy five months after my mother died of colon cancer? Health insurance is no guarantee of payment for proper health care. You're on your own whether you pay those high premiums or not.
The psychopaths are winning.
by Halcyon on Thu Mar 29, 2007 at 06:58:35 AM PDT
Kinda says it all. I suggested a call to Senators Spector or Casey might be a good place to start.
Why isn't a given test, medication or procedure covered? Where do we go for some answers? Could a Wall Street analyst possibly enlighten us?
Shares of Unitedhealth Group Inc. slumped Thursday after an analyst downgraded the health insurer in light of slowing commercial business and anticipated cuts to privatized Medicare plans from Congress.
. . .UBS analyst Justin Lake downgraded Unitedhealth to "Neutral" from "Buy," and lowered his price target to $59 from $67.
Lake said he does not believe that the stock will trade a meaningful premium to competitors, and the company will continue to post flat results in its commercial business excluding acquisitions. While membership losses are tapering off, an increase in spending on patients care is likely keep commercial profits flat, he said.
Unitedhealth reported a medical loss ratio -- the percentage of total premiums spent on patient care -- varying from 79.3 percent to 80 percent quarter-to-quarter last year for a 2006 MLR of 79.7 percent. Lake expects a half-point increase in 2007 to keep the commercial business flat
http://biz.yahoo.com/...
Don't start clapping. Despite the fact that UnitedHealth is spending a few additional pennies on healthcare as opposed to profit, waste and overhead, this is not good news. A rising medical loss ratio is bad news for UnitedHealth shareholders. Going forward this murderous company will come under fearsome pressure to make draconian cuts to healthcare spending. If you're a UnitedHealth policyholder, you have reason to be worried.
Back to my own situation. I pay a fortune every month for the privilege of having insurance known as a PPO (preferred provider organization). This means if I go to a participating doctor, as I did yesterday, I pay a nominal co-pay of $20.00. Then, in theory, the insurance company pays the "provider" a negotiated fee based on whatever transpired. Sounds logical. In fact, the sheet I was given with all the procedures that the insurance company would not pay for is a phenomenon known as cost-shifting. Despite dutifully paying our premiums month after month, year after year, insurance companies are on a wild orgy of cutting benefits and paying only when pushed to the wall.
The Murder by Spreadsheet delay, deny and deceive scams which in fact are the "business practices" of this unregulated and politician-friendly industry, is finally being exposed in of all places, the front page of the New York Times.
You can read the New York Times article here:
Aged, Frail and Denied Care by Their Insurers
http://www.nytimes.com/...
Some of you might say this is old news--for-profit insurance companies exist to take our monthly premiums and deny us care. You might also say, receiving a list of what an insurance company won't pay is an intelligent and honorable business practice in a healthcare system on the verge of total disintergration.
I say you're wrong. I say being handed a sheet of paper with a long list of what insurance companies are unlikely to cover represents a further bleak turning point in the collapse of our healthcare system. And mind you, this has nothing to do with "consumer directed" high deductible junk insurance. In theory, I don't have junk insurance. But these days theory is very misleading, we all have junk insurance.
And guess what, these bloodsucker insurance companies are smart. They know what so many of us do-- they deny a claim and we go away, we don't pursue them. What's the old saying, "a dollar here and a dollar there and pretty soon we're talking real money"? When I abandon my $60.00 claim, and you give up on yours--this is all more profit for the insatiable for-profit insurance industry.
Our premiums are skyrocketing, our co-pays are exploding, our benefits are being reduced, and the for-profit insurance industry is heaping more and more costs onto our shoulders. This is cost shifting, and for those among us financially unable to absorb any additional costs, this is also Murder by Spreadsheet.
Since we have a fragmented system of private, for profit insurance companies dictating whether we will receive treatment and the pennies on the dollar they will pay, I am sure all of us will be getting these friendly notifications (maybe I should call them, warnings) from our doctors with increasing regularity.