That would be your friendly neighborhood health insurance company. It's an interesting observation in itself that most of the important news about health care is to be found in the business section, which is why I always turn to Business Day first.
It turns out that Senator Rockefeller, although he doesn't seem to have a big problem with cooking up phony intelligence to start an illegal war of aggression (but I digress), is bent out of shape by health insurers cheating physicians and consumers. The latest scam has to do with payments for out-of-network providers. Insurers typically reimburse 80% of "reasonable and customary" charges, but it turns out they have been using phony intelligence to determine what these are.
This is just one more rotten turnip in the health insurance stew, of course. The only function of these companies is to squeeze profit out of the transaction between the ultimate payer and the provider making sure that people who really need health care can't get it, that people who do have insurance don't get the services they need, and that employers and taxpayers overpay them while they underpay providers. In other words, they are parasites who perform no socially beneficial function whatsoever.
If we had a single payer system, of course, there would be no such thing as an out of network provider. There would be one network, and all the providers would be in it. Contrary to the BS touted by the insurance industry and its ventriloquist dummies in the corporate media, you, the consumer, would have more choice, not less: you would be able to go to any doctor, any hospital, anywhere in the country, and you would be fully covered.
We need universal, comprehensive, single payer national health care.
Tuesday, March 31, 2009
The scum of the earth
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2 comments:
I can't recall a news story in the corporate media that doesn't start with some intro about "reforming" health care, the tears off into glorious, successful "reforms" such as in Massachusetts where everyone is required to purchase health insurance. My standard comment to anyone within hearing is, "Health insurance is not health care." I don't know whether it's sloppy journalism, or whether reporters travel in such circles that they've never had to worry about getting their insurer to fork over, but anyone who has gone to battle with an insurer will never confuse the two again.
And Cervantes, you must read Agnes's Jacket by Gail Hornstein. You absolutely have to. I kept thinking of this blog while I read it.
"reasonable and customary" has nothing to do with real life. most doctors operate in the insurance world, where the rates for services are reduced by contract. for those who operate outside insurance, there may be varying rates: a hearty rate for those who can afford anything, and maybe sometimes a low rate for uninsured people.
it doesn't surprise me in the least that ins. co's routinely undervalue the work of out-of-network provders. i suspect that is true even when the network offers NO nearby providers in a specialty.
do not get me going on insurance formularies, because i just spent days searching for a prescription item, calling various pharmacies, and finally came up with it -- but the copay turned out to be $45. i could have gotten the exact item from overseas, without a prescription, for $15 plus shipping. wtf?
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