One of the many frustration that everyone faces if they are lucky enough to have insurance, is dealing with that insurance company. It turns out they are playing games with us and that is not right. And it makes me very suspicious.
I was a classroom teacher and the wife of an administrator. That occupation had me rubbing shoulders with people that were not classroom teachers. Even by default I knew about how the group insurance companies worked.
For example, my teaching partner was on the committee from our teacher's union that chose what company and plan those of the rest of us would have to pay for. At that time a plan that my husband had set up many years before was the one being used.
With the old plan if there were teachers that were married, both of those people did not have to buy insurance. One insurance policy covered them both so the money that the union negotiated with the board to pay for insurance was put into a separate account to be saved for the teacher when they retired. It drove the insurance company nuts. All that money not being paid to them for insurance that no one needed did not work for them.
A very good insurance salesman convinced the committee to relinquish the perk. But here was the kicker. The policy the insurance company gave the teachers in that district was totally different from the policy given a school district only a few miles away. I don't know who was the winner and who was the loser. I think the insurance company representative saw it as a game or it may have been that they were rewarded for selling one policy over another. I do not know that for sure and never will.
So on another subject about insurance...have you ever been turned down for a claim, called the insurance company and been told that the claim would be paid because you called, that the company did that sort of thing as a policy? I imagine most people don't call and challenge the refusal to pay so it is a financial gain for the company. This company was MODA, one of the insurance providers used by our public retirement system in Oregon.
That leads me to pharmaceutical companies. I have taken drugs for high cholesterol for many years. I was simply amazed at how cheap generic drugs were compared to those that are not yet able to be labeled as generic. My insurance company paid thousands of dollars to those companies and I paid the co-pay. It is almost sinful.
I realize that a drug company invests a lot in research but why do I think that they take advantage of that mark up long after the research is paid for? I would love to be privy to that type of information!
I know that everyone has a story to tell and we all bring our own slant to those stories. I just want someone with an unbiased eye to tell me why?.
I think insurance companies and pharmaceutical firms need to be held accountable for their price increases, we need to be able to go across county (not even possible in our state) and state lines to shop for insurance coverage. If we knew more, we would not suspect that they all took advantage of Obama Care for their own gain.
There is something that stinks...all we need to do is figure out where that smell is coming from and clean it up. It could be as simple as using a little common sense.
b+
Note: I am one person that thinks everyone should be insured, much like our laws that require car insurance. We do it with Medicare. It comes with a cost but a healthy nation is a financially successful nation. It all just follows.
I was a classroom teacher and the wife of an administrator. That occupation had me rubbing shoulders with people that were not classroom teachers. Even by default I knew about how the group insurance companies worked.
For example, my teaching partner was on the committee from our teacher's union that chose what company and plan those of the rest of us would have to pay for. At that time a plan that my husband had set up many years before was the one being used.
With the old plan if there were teachers that were married, both of those people did not have to buy insurance. One insurance policy covered them both so the money that the union negotiated with the board to pay for insurance was put into a separate account to be saved for the teacher when they retired. It drove the insurance company nuts. All that money not being paid to them for insurance that no one needed did not work for them.
A very good insurance salesman convinced the committee to relinquish the perk. But here was the kicker. The policy the insurance company gave the teachers in that district was totally different from the policy given a school district only a few miles away. I don't know who was the winner and who was the loser. I think the insurance company representative saw it as a game or it may have been that they were rewarded for selling one policy over another. I do not know that for sure and never will.
So on another subject about insurance...have you ever been turned down for a claim, called the insurance company and been told that the claim would be paid because you called, that the company did that sort of thing as a policy? I imagine most people don't call and challenge the refusal to pay so it is a financial gain for the company. This company was MODA, one of the insurance providers used by our public retirement system in Oregon.
That leads me to pharmaceutical companies. I have taken drugs for high cholesterol for many years. I was simply amazed at how cheap generic drugs were compared to those that are not yet able to be labeled as generic. My insurance company paid thousands of dollars to those companies and I paid the co-pay. It is almost sinful.
I realize that a drug company invests a lot in research but why do I think that they take advantage of that mark up long after the research is paid for? I would love to be privy to that type of information!
I know that everyone has a story to tell and we all bring our own slant to those stories. I just want someone with an unbiased eye to tell me why?.
I think insurance companies and pharmaceutical firms need to be held accountable for their price increases, we need to be able to go across county (not even possible in our state) and state lines to shop for insurance coverage. If we knew more, we would not suspect that they all took advantage of Obama Care for their own gain.
There is something that stinks...all we need to do is figure out where that smell is coming from and clean it up. It could be as simple as using a little common sense.
b+
Note: I am one person that thinks everyone should be insured, much like our laws that require car insurance. We do it with Medicare. It comes with a cost but a healthy nation is a financially successful nation. It all just follows.
Insurance is a complex business - and it is a disgrace that people feel the need to hire lawyers just to get what is in the terms of the policy. For anyone who owns an insurance policy, the obvious advice is to read your policy - but enough of them are so hard to understand. And why should that be?
ReplyDeleteMaybe we need an "Insurance for Dummies" book so we can figure it out. I suppose if we get mad enough we will take the time to read and decipher every line. I will say that Moda does seen out notification to my email and I hate to read them. Bad on me!
DeleteFirst, insurance companies are in business to make money. Second, they are in business to make more money, any way they can. Third, they are in business to make as much money as they possible can squeeze out ot their customers, either through premiums or by minimizing payouts. Period. That's my humble opinion.
ReplyDeleteWell, that is what a "business" is isn't it? Could that be why the health insurance we buy should be taken out of the for profit realm for ever? At the very least more supervision is required.
DeleteBe careful what you wish for Barbara - do you really want to have to compare so many "PDS"s which are written by a posse of lawyers? Alana they are hard to understand because they are updated every 6 months and reviewed by so many people that they become unreadable. I agree Dinata it is a disgrace that we have to have a financial adviser to decipher our insurance and investments.
ReplyDeleteWith regard to the price of drugs, the companies pay out a LOT of money to doctors. Find out more here! https://openpaymentsdata.cms.gov
It's the unacceptable face of capitalism!