see links below
Our web site effort relates particularly to South
Carolina, but much applies anywhere in the USA.
From then
to now:
Paying the bills for health problems used to
be (prior to 1960) like shopping for anything else. Then, health
care became a "right"...leading to government programs...leading
to a huge money infusion into "the system". As (1) patient
expectations heightened, (2) malpractice lawyers obtained
huge judgements which caused doctors to practice "defensive
medicine", (3) government programs proliferated & encouraged
people to use "the medical system", and (4) explosive
growth in expensive & highly advantageous technology entered
the picture, costs to patients skyrocketed. Originally there were
two parties in the transaction: the patient and the care provider (doctor,
hospital, clinic). Because persons could be "wiped out" by
sudden and unplanned health costs, third party payers entered
the picture as vehicles to insure, prepay, or cover costs through
various programs.
NOTE: Did you realize that two religious groups see "insurance"...unless required by law...as a form of wagering/gambling that also earns by interest/usury? Many Amish and Muslims hold such a view.
Your impact
on costs:
You are not required to take every suggestion your
doctor or any other provider might offer or want you to do. See
what it will cost. Don't be afraid to say, "I can't afford
it." And you can help yourself by learning how to have a healthier
lifestyle,
Why insurance...what's
it for?
The fundamental idea of insurance is to
protect yourself against "wipe outs". The insurance "policy" is
your health insurance contract, whether your coverage is
obtained & carried through your employer (the company is
the customer) or a group (the interest group is the customer) or
personally and privately by yourself (you are the customer...and
you will find that these contracts are often vague and/or hard
for regular people to figure out). And you may need copies of specific
wording in it. Typically, third party payers (the insurance program)
pay a large part of many claims and you pay the smaller part.
How much
will insurance cost me?
The cost to you for insurance tends to be related
to the riskiness of that 3rd party payor's total number of customers
covered plus an estimate of how risky you are plus a company decision
of an annual profit target.
Getting
doctor & hospital bills paid:
Filing a claim is your responsibility & requires
highly exact information. Many health care providers will file
claims for you. SO, you must always provide
the "provider" (doctor, hospital, clinic) with up-to-date
insurance card information because many providers
will provide claims filing services free to you, especially if
you will help them to help you (see below)!
Keep firmly in mind that, even though most citizens
are not able to discern the complexities of the financial aspects
of our health care system (and the third party payers know and
count on this), you have paid your premium in good faith in
order to purchase the coverage! A high percentage of health-care providers will legitimately ask
for entire payment of fees up front and take the responsibility
of sending you a refund after they actually
get your payment from the third party coverage. This has to be
done because you have made the insurance company your agent, and
those companies often hassle the providers (especially through
means of multiple "delaying game" tactics). But, you
might consider that all of business society elsewhere is sometimes
willing to give a "prompt payment discount"...ask
for it in exchange for prompt entire payment.
Take the attitude (it need not be a confrontation)
that a patient and the patient's providers all desire a long-term
and pleasantly recurring relationship (partnership...you are the "customer")
on out into the future. Providers even hope that patients refer
other patients to them! Therefore, you should feel natural as you
ask providers to disclose all of the ways they know of which can
be a positive contribution to your financial & health
advantage ("Have you got any tips on how I can save money
on costs?")!
Finding
the best health insurance:
Aetna & the Financial Planning Association have
launched a website to
help educate you on looking for the best plan for you. The S.
C. Hospital Association web site has
a "consumer info" button which links to a "glossary
of health care terms" which you might find handy. California
has a site with tips about dealing with HMOs.
The American Health Information Management Association's web site
has info explaining what the "medical record" is and
your rights concerning the record (and
a file of FAQs).
Warning!!!
Cardinal rule: never
threaten using a lawyer or law suit (why? because the parties can't
legally co-operate with you once you draw that line in the sand...they
must then work through lawyers). If they will cooperate and be
receptive, try to use your efforts in cooperation with your provider's
billing department (most of whom file claims for you but rarely
do much actual "fighting" in your behalf...it costs them
too much in personnel time to take on a fight...think of that billing
office as a sort of "coach" who can advise you on what you can
do to help your cause). The providers and their billing and social
worker services are your friends and partners.
(posted Aug. 2001;
latest update 19 June 2006) |
