Antares in NYC
Senior Member
- Messages
- 582
- Location
- USA
What @SOC said!
The obscene overcharging and the wanton approval practices of the insurance companies in the USA have nothing to do with the ACA. It's part of the game. Even the CEO of Kaiser-Permanente said it in so many words when they first proposed the HMO model to Richard Nixon in the 1970s:
It's a rigged game from its inception, folks.
I don't disagree with whodathunkit in that government-based health systems also have their problems (look at the dramatic cuts to the NHS currently taking place in the UK). That said, the inherent problem with the American private insurance model is that greed prevails over the health of subscribers. Profit above everything else.
Let me give you a personal example, one of many during my sad and arduous battle with ME/CFS:
A few years ago I was freelancing, and before the ACA, there were barely any options at all for insurance coverage in New York city. I had to join trade associations in order to get something resembling a health plan. This was an insurance plan with extremely high deductibles, and required me to pay south of $1000 a month in premiums. That was one of the very, very few options in NYC to get insurance if you worked on you own, just a few years back.
As my ME/CFS problems progressed, I needed a specific type of endoscopy. I waited until I met the obscenely high deductible to request the procedure. Had to request pre-approval from the insurance company with letters from my doctors, but in the end, they pre-approved it, and I got the endoscopy done.
A few weeks after the procedure I receive a notification that the insurance company declined payment for the endoscopy. I was explained that pre-approval does not guarantee they would agree to cover it, and that their panel of experts decided that this was not to be covered. Like that. As if I had that kind of money laying around, you know...
It took months to fight them. Took them to arbitration, and in the end they didn't pay a danged thing! I had to settle with the hospital, doctor, anesthesia specialist, etc, and arrange a payment plan for that procedure. For the record, I finished paying for that endoscopy this last June. This, on top of the dozens of other medical bills mounting because of my condition.
So you scrambled to get your private insurance policy, paid massive premiums, had to meet sky-high deductibles, and then they could deny coverage on a whim, leaving you out to dry. Basically a legal ponzi scheme.
At least with the ACA now I have options for better insurance plans, and the endoscopy is now covered mandatorily. Not saying that it's perfect --I have my issues with the ACA, but the system won't improve as long as greed is at the core of the healthcare industry. But let me tell you, this beats what we had before.
One thing I know for sure, this wouldn't have happened in Europe. Their systems have other problems, for sure, but not this outright rapacious skimming of patients. I have close to zero respect for the private insurance firms and the people that run them, and it's based in painful personal experiences.
The obscene overcharging and the wanton approval practices of the insurance companies in the USA have nothing to do with the ACA. It's part of the game. Even the CEO of Kaiser-Permanente said it in so many words when they first proposed the HMO model to Richard Nixon in the 1970s:
"All the incentives are toward less medical care, because—the less care they give them, the more money they make." - Mr. Erlichman quoting Edgar Kaiser to President Nixon on February 17, 1971
It's a rigged game from its inception, folks.
I don't disagree with whodathunkit in that government-based health systems also have their problems (look at the dramatic cuts to the NHS currently taking place in the UK). That said, the inherent problem with the American private insurance model is that greed prevails over the health of subscribers. Profit above everything else.
Let me give you a personal example, one of many during my sad and arduous battle with ME/CFS:
A few years ago I was freelancing, and before the ACA, there were barely any options at all for insurance coverage in New York city. I had to join trade associations in order to get something resembling a health plan. This was an insurance plan with extremely high deductibles, and required me to pay south of $1000 a month in premiums. That was one of the very, very few options in NYC to get insurance if you worked on you own, just a few years back.
As my ME/CFS problems progressed, I needed a specific type of endoscopy. I waited until I met the obscenely high deductible to request the procedure. Had to request pre-approval from the insurance company with letters from my doctors, but in the end, they pre-approved it, and I got the endoscopy done.
A few weeks after the procedure I receive a notification that the insurance company declined payment for the endoscopy. I was explained that pre-approval does not guarantee they would agree to cover it, and that their panel of experts decided that this was not to be covered. Like that. As if I had that kind of money laying around, you know...
It took months to fight them. Took them to arbitration, and in the end they didn't pay a danged thing! I had to settle with the hospital, doctor, anesthesia specialist, etc, and arrange a payment plan for that procedure. For the record, I finished paying for that endoscopy this last June. This, on top of the dozens of other medical bills mounting because of my condition.
So you scrambled to get your private insurance policy, paid massive premiums, had to meet sky-high deductibles, and then they could deny coverage on a whim, leaving you out to dry. Basically a legal ponzi scheme.
At least with the ACA now I have options for better insurance plans, and the endoscopy is now covered mandatorily. Not saying that it's perfect --I have my issues with the ACA, but the system won't improve as long as greed is at the core of the healthcare industry. But let me tell you, this beats what we had before.
One thing I know for sure, this wouldn't have happened in Europe. Their systems have other problems, for sure, but not this outright rapacious skimming of patients. I have close to zero respect for the private insurance firms and the people that run them, and it's based in painful personal experiences.
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