The “Health Insurance Card” and Health Insurance have taken on an importance in everyday life. These two items have, in a way, taken on a life of their own. Amidst today’s fervent, raging and emotionally charged debate over health care reform, the whole concept of Health Care Insurance should be re-evaluated. This is just one Health Care practitioner’s perspective on one small aspect of health care delivery. It is fueled out of my confusion that patients don’t seem to understand their personal responsibility for payment of the services (care) that they receive (purchase). It is almost as though health care has been devalued to the point that we don’t comprehend paying for it.
There is much confusion regarding the role and use of health insurance. Health care coverage is a product. It is sold to you, the consumer, by businesses. The business’ product is “health care coverage.” Coverage varies depending on the plan that you purchase. Cost of the “plan” varies depending on the scope of the coverage. Just like the size, quality and performance of an automobile may vary depending on the price you are willing to pay. The more you pay, the more you get. Health care insurance coverage works the same way.
Companies providing health care insurance are profit making businesses. They are not charities. I am hearing a great deal of mumbling (ok it’s more like shouting) about the profits that these companies are making. Many of us own stock in these companies in the form of our mutual funds. They are supposed to be profitable. Why are we thinking that there are moral dilemmas inherent in profiting from helping someone improve their health? Why should saving a life, solving a skin rash problem or counseling someone on being a better parent be non-profitable ventures? Can I be the only one seeing the benefit in all of these? I would pay for these. And if we wouldn’t pay for these services, is it the services themselves or our own selves that we fail to value?
Most people don’t even realize the single largest benefit to being enrolled in a health insurance plan. The largest benefit to health care insurance is that it buys the consumer a discounted rate for any health care related services that it covers. This is the biggest single benefit and most consumers don’t even realize it. When a provider is “participating” with an insurance company they agree to accept a fee lower than their full regular rate. HMO and POS plans pay the lowest fee to providers. PPO plans pay better, but still lower than the provider’s full rate. When a provider is “participating,” they always accept a “negotiated fee schedule” which is lower than their regular rate. The patient is responsible for only a co-payment as long as healthtipsae provided remain within the benefits of the plan that they purchased. If the desired service is not covered in the insurance plan, the consumer is responsible for payment in full. Referencing back to the automobile analogy, if your care didn’t come with 20 inch rims and you want them, you have to buy them. You don’t expect the car dealer to pay the auto store for your rims.