Why health insurance plans are so expensive

US-PDGov

By Jessica Myers

Health insurance is one of those necessary evils. Many Americans can’t afford it, however, and are left uninsured and at-risk for having to pay high medical bills. Obamacare has instituted a plethora of changes - with more changes to go into effect soon - that aims to lower the cost of health insurance and make it accessible to everyone.

What happened, however, to get us to this sorry state of affairs? In other parts of the world, health insurance is given to everyone free, as part of them paying their taxes. Health care is much more inexpensive, even for the same or better quality care. Why do Americans have to pay health insurance premiums and medical bills that are so high? Why is health insurance so expensive? Here are just some of the reasons.

History

Health insurance companies were originally ran by doctors and hospitals, and it was simply a means of helping people pay for their bills. Back then, it was with good intentions, and it helped a lot of people who had poor health and lots of bills. Eventually, however, finance professionals took over health insurance companies, and that’s when things began getting a lot more complicated. Insurance companies knew they had the potential to make a lot of money, and they started finding ways to do it. Health insurance wasn’t just about helping people anymore.

Profit over Care

Unfortunately, health insurance still isn’t really about helping people. The insurance companies will try to tell you differently, of course, but what they’re most concerned about is their bottom line. If someone needs expensive procedures in order to survive or vastly improve the quality of life, they have to jump through hoops to get it approved by insurance companies who want to deny it simply because they might not earn as much money because of it. People who really need care often go without it because health insurance companies have profit-motivated policies. If this seems absurd, it is.

Inflated Costs

In order to make it seem like you’re saving a ton of money with your health insurance, billing charges are almost always highly inflated. A 10-minute visit to the doctor may be billed for $200. A procedure that costs $1,000 may be billed as $10,000. With health insurance, you pay only a copay or a portion of the bill, and you feel like you’re saving a ton of money. In reality, no one is paying that much for the services. The doctor that billed your insurance company $200 might receive half of that.

Preexisting Conditions

Another reason health insurance costs so much money is that your premium costs rely on your health condition. Obamacare will change some of these things, but in the past, you might not even be able to get health insurance when you’re sick. If you do get it, they might not cover your preexisting conditions at all, and they’ll charge you a lot more than a healthy person. In addition, costs for healthy people will rise simply to help cover the costs to insurance companies for covering sicker people.

About the author: Jessica Myers is a retired insurance professional and freelance writer that shares tips to help decipher insurance and their complicated policy details.

Cheating insurance companies deny patients proper care

By Aaron Gormley

We all know that there are many areas where health insurance is suffering in this country. One of the most frustrating examples of this is in the area of so-called experimental treatments. Insurers are routinely denying patients important healthcare because they have labeled certain treatments as investigational or experimental.

Another frustrating part of our struggling healthcare system is insurers who don’t cover preventative treatments that can actually prevent a more serious disease from forming. An example of this is that an overweight person who does not bring his or her weight down may develop diabetes.

TMJ Surgery

A good example of the ridiculous concept of experimental treatment is that of reconstructive surgery for TMJ. An alloplastic hemiarthroplasty of TMJ has been proven to be successful for fifty years. Insurance companies have labeled this surgery as experimental. To further confuse the issue, they will cover multiple autologous grafts that have a 69-90 percent failure rate.

Does this make even the slightest sense? Deny a patient surgery that is proven to work, but approve a surgery that is known to fail. It’s ludicrous. The health of Americans will never improve if insurance companies continually make these decisions.

Gastric bypass surgery

Gastric bypass surgery is a surgery reserved for those persons who are morbidly obese. They must be at least one hundred pounds overweight and tried other weight loss methods before being medically eligible for gastric bypass. However, just because a patient qualifies for the surgery does not mean the insurance company will cover it.

Although some insurance policies are beginning to cover this procedure, there are many that still won’t. Yet if these obese patients do not get help, they are at risk for diabetes, heart failure and other health problems. One study proved that very few states ensured coverage of obesity, even though it is seen as one of the most challenging health problems Americans face.

Not covering preventive care

Most people think of preventive care as a complete physical exam once a year, but it is much more than that. For instance, an overweight person can develop diabetes or sleep apnea if they do not get their weight under control. The insurance company will cover treatment for diabetes, but will not cover weight loss treatments that could prevent diabetes in the first place.

The same concept applies to conditions like sleep apnea. Sleep apnea can affect anyone, but overweight people are at a higher risk. If the insurance companies would step in and help overweight patients lose weight, they would not have to later cover conditions that were brought on by the obesity.

What the insurance companies say

Insurance companies try to insist that they will conduct reviews of new treatments to determine if they should be covered under their plan. Reading their handbook will lead a patient to believe that they are doing everything they can to research these treatments and eventually provide coverage. This is far from the truth, as this article shows.

If insurance companies will not cover a TMJ procedure that has been proven to work for fifty years, it is highly unlikely they will cover something that has been on the market for only five years.

The sad part is, while the insurance companies are dragging their feet about covering certain treatments, people continue to die. It’s a shame and the healthcare in this country will never be healthy until insurance companies are prevented from making these types of exclusions.

About the author: Aaron Gormley writes on all financial topics, from insurance scams to how to find CDs that yield high rates.