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.

Guest post: Affordable insurance alternatives for your kid's healthcare

US-PDGov

By Carol Wilson

There's nothing more stressful than getting a job that provides you, the employee, with health benefits but does not extend them to your family, especially the person who needs it the most—your child. Worried that your uninsured child will get severely ill or injured throughout the school year can be one of the most unsettling things you can experience, trust me I've been there.  While you may not be able to afford private insurance for your child, there are a few other options you might have incase a medical "emergency" occurs.

Health Savings Account (HSA)

The first thing you can try to do is set up a health savings account, which is typically just known as an HSA. HSAs are specifically designed to help pay for unexpected medical expenses that may arise throughout the year as well as help you save up for any health costs you already know your child will be needing in the future, like braces or glasses. HSAs are tax free and personally controlled, so you decide how your money is invested. Your HSA is not affected if you switch jobs and does not close out—meaning there is no "use it or lose it" clause. 

In order to qualify for an HSA, you must be enrolled in a high-deductible, employer- funded or independent health insurance plan. Or you can acquire one through a credit union or bank.

Medical grants

Every year a handful of grants, like the ones awarded by the United Healthcare Children's Foundation, are given to help families cover medical expenses for their children who are partially or not covered at all by health insurance. It may take some diligent research and your child may need to meet certain qualifications, but it most definitely is an option.  Grant money does not need to be paid back to the government. 

Christian Medi-Share 

This option is a bit limiting since it's only offered to those that practice the Christian faith. But if you and your family are proclaimed Christians and can prove that you all uphold a Biblical lifestyle, then it's most definitely worth a shot. How it works: the medi-share organization you choose receives voluntarily monthly contributions which are then disbursed to its members. Unlike health insurance, covering your medical expenses is not guaranteed. Some months may be better than others. There is a fee to be a medi-share member.

Discount dental plans

Lastly, you can enroll in a dental discount plan as an alternative to costly dental insurance, like the one Aetna provides. For a yearly fee, discount dental plans help families locate dentists "in-network" so to speak to help find dentists who accept the discount cards and offer services at a reduced price. Some members can get as much as half off of on costly dental work like braces. 

Carol Wilson regularly contributes to www.businessinsurance.org; 

she loves covering health, auto, and home insurance topics too. She welcomes your comments and feedback. 

How to save money on surgery

Low cost high quality surgery may sound like a contradiction but isn't always the case. The reason highly valued medical services such as surgery can be obtained at a low cost is due to improved international health care training. Moreover, international medical operations that develop at a faster pace than standard of living in addition to different medical business models overseas can save money on surgery. 

In other words, when well trained doctors and dentists live in countries where the standard of living is lower, health insurance and surgery tends to be cheaper for individuals coming from economies with a higher standard of living; going to these countries for surgery can save money. Thus, finding low cost high quality surgery is an advantage for those patents who can take advantage of exchange rates, and geographic variation in cost of services.

Where to find cost effective surgery

Saving money on surgery does require a little research, after all, life is a precious thing and if one didn't value life, surgery wouldn't be necessary in the first place. Having said that, different countries have different surgical advantages. For example, for individuals in the United States seeking more cost effective cosmetic surgery, why not consider Mexico? The travel costs are relatively inexpensive, especially via automobile and the net medical costs are a lot cheaper. Additionally Doctors that are Board  Certified can be referred through former patients, referral services and Doctors.

If you're in the market to save money on heart surgery and don't have insurance don't despair just yet. Heart surgery costs in India might be able to give you a bypass for a few thousand dollars compared to the tens to hundreds of thousands charged in the U.S. If you're wondering if the Doctors there can be trusted with you heart, research might give you confidence. According to the Economist magazine (2), Indian hospitals have developed smarter and cheaper ways to provide quality heart surgery to patients. Moreover, some Indian medical models are being duplicated and sold to other countries.

The list of places to go to save money on specific surgery goes on and essentially involves what is known as medical tourism. Medical tourism is an industry that is comprised of patients, patient's families, specialized travel agents, medical facilities, and medical networks.

Surgery via the medical tourism industry

The medical tourism industry is growing according to health-tourism.com (1) and is attractive to both patients and health providers for a number of reasons stated in a an article by Forbes.com. (3) There's no doubt, globalization has created a more competitive playing field when it comes to current international medical treatment and costs. This lowers the cost of high ticket health care items such as surgery depending on the location and type of surgery.

Costs to keep in mind when considering medical tourism include pre-hospitalization stay, travel, post-operation facility, and any therapy that may be required after the surgery. If the total costs after individual and family travel are significantly lower for a surgical procedure similar to or better than a local procedure, then medical tourism may be a wise choice to save money on surgery after additional considerations and contingencies are also considered. For additional information on researching and obtaining medical treatment abroad, the following resources may be helpful.

• Patients without borders

• Medical Tourism Association

• Healthbase

• Med retreat

Medical tourism has emerged for a number of reasons including excessive costs of health care in foreign countries, lower operating costs in other countries, improved international medical professional training, differentials between medical care and standard of living, and improved medical operations. Individual patients might do well to take advantage of the plethora of potential benefits available through medical tourism. Life is precious, but it might end up costing less for an even better medical result with medical tourism.

Sources:

1. http://www.health-tourism.com/medical-tourism/statistics/
2. http://www.economist.com/displayStory.cfm?story_id=13496367
3. http://www.forbes.com/2006/10/25/health-medical-tourism-biz-cx_1026oxford.html
4. http://www.time.com/time/magazine/article/0,9171,1003450-2,00.html
5. http://healthbeyondborders.files.wordpress.com/2009/01/med-tourism-cost-comparison.jpg