[Masthead] Fair ~ 52°F  
High: 60°F
Saturday, Jan. 21, 2017

Health Insurance

Posted Tuesday, February 26, 2008, at 11:25 AM

I don't know that a plan like Canada has in the best alternative for the U.S. I do have good health care coverage and consider myself lucky for it, but the "invasion," for lack of a better word, of the insurers themselves on the process of patient care has been increasing and shows few signs of letting up. In my case, the situation is not life-threatening, but I know of other cases where it has been.

The "dreaminess" of one of my favorite actors notwithstanding, I feel sure there are better alternatives to our current health care system, and look forward to a solution from our next President, whomever he or she may be.

Showing most recent comments first
[Show in chronological order instead]

While it is true licensed insurance adjusters do not need a medical degree, that does not mean that they act in a vacuum. While a licensed adjuster, my company had a deparment manned by RN's and BSN's to work as nurse case managers and general resources for us. In addition, there are entire companies who hire nurses and doctors to act as on-site case managers. Many states such as Texas and Florida require additional training beyond the nursing or bachelor degree level to be licensed to operate as a case manager within their state. In addition, several states require medical information be sent to an independent medical examiner for approval of medical treatment. For example, the first two weeks of physical therapy occurring within the first month after an injury is covered. After that, each additional set of 6 week increment treatments must be reviewed and authorized by an independent, state licensed doctor. (personally I always saw this as a way for Texas to get money). Lastly, adjusters work very closely with medical personnel. Do you have a medical degree or enough experience to determine your own best medical care? Do you believe a doctor with a share in the clinic and who just bought the brand new, expensive MRI machine always has your best interests at heart?

-- Posted by koeller75 on Thu, Mar 20, 2008, at 12:30 PM
Nope, no medical degree in my background, and nope, I don't believe that every doctor, in every case, has an "untainted" interest in patient care.

That said, I don't like the idea of someone whom I have never met, who has only medical records to rely on, and who, it is important to note, is paid by the insurance company, making the critical decisions as to what the patient needs or does not need.

I have also dealt with in-house company doctors and case managers who are paid by the company we both work for - again, their interest can hardly be called unbiased.

What I see as the problem is that patients are often regarded as fakers and goldbrickers by people who do this kind of work, whether it is as an insurance case manager or a company's in-house doctor. Such patients certainly do exist - no one would bother to deny that. But it is unproductive and harmful to patients who do not fall into that category to be treated in that fashion, and made to feel as if they are asking for something to which they are not entitled.

I will continue to insist that the doctor who treats the patient, who has the first-hand experience and contact with the patient, as the best source of information, infallible as that source may be.

what do i think is to blame?

a major factor is our litigious society. our legislature can help the current state of affairs with medical tort reform.

what do you think?

-- Posted by SecretAgentMichaelScarn on Mon, Mar 3, 2008, at 7:48 PM
Kathy Fairchild's response:
I think that's certainly part of the picture. We've somehow been led to believe that every medical outcome will be rosy, and when it isn't, we run to the nearest lawyer for a remedy. On the other hand, there must be some penalty to doctors for egregious errors and downright incompetence. As always, there is a middle ground we need to reach, if we can.

More on my personal experience - I was at the doctor's office last week, and needed an ultrasound to determine if post-operative pain I was having was caused by the presence of a blood clot, a potentially life-threatening issue. The doctor could not order the test until my insurance carrier okayed it in advance. Once again, the doctor is being hampered by the insurance company, and I think that's ridiculous. To be clear on this situation: my doctor has given me outstanding care, and I am in no way being critical of thd doctor or the hospital where I'm being treated - but I am less than delighted by what I regard as interference by the insurance company in that process.

BACK to the issue at hand...I think it's scary that insurance companies can direct patient care. I'm unaware of any regulation that requires an insurance claim adjuster to get a medical degree!

-- Posted by koeller77 on Wed, Feb 27, 2008, at 8:56 AM

I agree, Canada's model has even more problems. Same with the Dutch model.

-- Posted by SecretAgentMichaelScarn on Tue, Feb 26, 2008, at 12:38 PM
Kathy Fairchild's response:
From what I've read, those countries with what most would call "socialized medicine" have a tax system that is nearly confiscatory. With the dollars spent nationally on health care and insurance already, surely there is a better way for everyone to have adequate coverage at a reasonable cost.

Who or what do you think is to blame for the current state of affairs? Medical school costs? Doctors' salaries? Greedy insurance companies? The cost of drugs and doctors' services keeps going up, fewer people are insured and those who are insured have less covereage at a higher cost - the last 20 years in the health care business have been nightmarish on all sides. I'm thankful to be mostly healthy, with pretty good insurance, but worried about the effect that the current situation will have on future generations, including my grandchildren.

Respond to this blog

Posting a comment requires free registration:

Kathy Fairchild received a Bachelor of Arts degree in business administration in 1986 from Marycrest College, Davenport, Iowa. She is also a 2003 graduate of the paralegal program at New York University. She moved to Marshall in 2006, following a career of more than 30 years with the world's largest farm equipment manufacturer. She is an Air Force brat and grandmother of four.
Hot topics
Lost Weekend
(1 ~ 12:41 PM, Mar 25)

Please help me, I'm fallin'
(3 ~ 6:07 AM, Sep 9)

Jukebox Democracy
(8 ~ 9:43 PM, Aug 19)

We're this close
(0 ~ 10:55 AM, Jun 9)

Part of the function of memory is to forget*
(5 ~ 9:31 PM, May 30)