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Wednesday, December 5, 2012

Insurance in the land of the free

   The homeowner and auto insurance is carried by the same provider. We have been doing business with them for more than twenty five-years. They are not the inexpensive providers you hear advertised on tv. They are not the sort of organization that argues with every claim, instead they pay promptly  and courtesly. Like when the roof was damaged with hail from a tornado, there were no problems about the claim and the payment was made right away, and we got the roof fixed.

  For the autos it is an interesting dilemma, one was bought used in nineteen ninety seven for thirty thousand dollars and paid for in installments with interest. That car now, looks good, the paint still shines. It was a lemon, a very expensive lemon, with repairs each year at about a minimum of another thousand dollars. We kept fixing it because a thousand is cheaper than buying a new one, and we are surprised each year but the new problem, something we never heard of before, or since. So we keep fixing it.  We carry collision on it, which means they will replace the car with with the same thing or an equivalent of the same value. The car is now worth on the blue book listing at about three thousand dollars. Collision insurance fees go up each year even though the price of the car goes down each year. We debate dropping collision, but if someone hits us and totals the car then we would have to pay for the collision repairs. And usually when an accident happens it is when one can least afford it. So each year we complain or try to get the rate reduced, instead we keep raising the deductible, our out of pocket expense before the insurance company will begin paying. We want to keep the car till it dies completely. A new car is an expense we do not want to incur if we can help it.

  The other car, truck really, used to cart hay, seed, equipment and anything we need to maintain the farm. It was bought six months after the other car we have. The price was about sixteen thousand dollars, and has not been an expense since we got it. We have only had maintenance charges, oil change, tune up, tires, and air conditioning refills. Both machines have more than a hundred  thousand miles, the truck is closer to a hundred fifty thousand.

  The only other insurance we have is health insurance.  We got the changes in policy for twenty thirteen, and it is one confusing document, actually three confusing or incomplete documents requiring a phone call to the provider for clarification.

  Of course, we get the voice that offers to assist or redirect the call to a real human, but that does not happen immediately, we get the next voice that informs us that we know that we can go to the company web site to get all our questions answered.
The the next voice, after listening to some static melodies, tells us that our call is important to them. Reminds me of the phone call we got from Mitt Romney, the intro voice tells us that Mitt is contacting us with some very important information, then a recording of Mitts voice is heard. If it is such important information he wants us to have, he should have called us himself, or gotten a real person to make the call. How do we know, it was really from him, how do we know he is real. But I digress, this discussion is about insurance in a free country.

  The new changes talk about who the insurance company wants us to do business with. The insurance company is telling us that they have preferred providers and non preferred providers and the price for prescriptions differs accordingly. If we do not do business with the companies they want us to use, they prescription we get filled. Here is where it gets tricky. They sort the various drugs or medications into tiers, and they further sort the tiers into generic or non generic or brand names. The co-pay for the generic drugs is less than for the brand names, and the co-pay is further sorted into tiers. Tier one drugs have the lowest co-pay, all the way up to tier five, which is exactly thirty three percent of the cost of the drug. But ninety day supplies are cheaper than thirty one day supplies.  Now if you think you got that all sorted, it is further, still, changed, because there are some drugs that must have prior authorization before the company will pay any part of the prescription charge. And there  are some drugs that are not on the list in the printed documents received, so either the website must be visited or a phone call to listed to all those voices and static music, and it is an important call to them so we must hold on until they are finished with us.

 Now this is just an explanation of the drug part of the insurance. Anyone in need of medical insurance, especially some who have chronic illness or 'conditions', are in less than optimal operating order and must then have someone read all the info and explain it so they can understand it, or call or visit the company website and have it explained to them before they can explain it to the insured.

  Then, of course there are the other rules the insurance provider has set down. Such as which procedures they will pay for, and where they are done, and for some, who will provide their medical care is also dictated.

  So, in summary, it use to be that the patient and the patients health provider  decided the course of treatment, then the government stepped in and decided which health care providers would provide which care, and now it is the insurance companies which tell us, what treatments and treatment providers are right for us. They also tell the treatment providers exactly how much they will pay them for any service, no matter what the provider wants to charge. Doctors can no longer prescribe over the phone for a patient, they must see the patient before any service is provided. Hey doc, I think I have pneumonia and out to be admitted to the hospital, can you please make those arrangements? No, you either make an appointment to see me at my convenience or go to the emergency room. 

  Now, besides these dilemma, the doctor shortage is also adding to the difficulties of getting medical care. The AMA controls the amount of doctors graduated each year, to keep their income at high levels and demand at equally high levels. Good for job security except if all the patients die waiting to see the doctor.

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