Medical Insurance

A hot topic these days for politicians is affordable health insurance for all Americans. That sounds good on the surface, but for it to be beneficial the entire system needs to be revamped. For those not familiar, let me explain the situation that exists, at least for me.

I currently have health insurance but that does not guarantee that I will receive quality medical care. Top doctors, particularly specialists, are not in my network. The majority of the providers that are in my network received their medical training somewhere like Haiti and operate their practice from a van they share with a carpet cleaning service. Cutting edge, state of the art procedures are not available to me. Blood letting, sorcery, and sacred dances are the treatments I can realistically expect.


The reason the best doctors do not choose to participate in my care is that they can’t make any money. If a doctor agrees to participate in a network it means he essentially allows the insurance carrier to dictate how much he will be paid.

Many actions are not covered and many others require pre-authorization in order to be covered. Let’s say I need a treatment that the doctor charges $2,500 for. If the course of action is covered the insurance company may only authorize $175 for that procedure. Between the insurance company and myself, we will pay the doctor $175. So the doctor must write-off $2,325. It is not hard to understand why the top doctors are not willing to play that game.

Should I choose to survive and visit an out-of-network doctor that actually has a fighting chance of curing what ails me, I am essentially on my own. The doctor bills me $2,500 and I am obligated to pay that amount regardless of whether my insurance company participates or not.

So if a few million additional sick people are dumped into that system, the few participating doctors will be so overwhelmed that the chances of actually seeing even the least qualified doctor prior to being pronounced dead becomes very slim. Countries with socialized medicine, such as England and Canada, have long waits for needed procedures.

Many of you have seen the television commercials for the Cancer Treatment Centers of America. They are amazing hospitals that boast the most advanced cancer treatment and an amazing success rate of cure. But most of us will never be able to afford that level of treatment. I took this statement directly from their website:

What are my responsibilities?
As a courtesy to you, we will file your insurance claim based on the information you provide. Your signature will be required to assign benefits directly to the hospital and physicians. We encourage patients to review their policy so there are no hidden surprises that might occur. We will work closely with you and your insurance company to expedite the process. Unfortunately, we may not always be able to obtain prompt or full payment from your insurance company. If that happens, you will be expected to assist in expediting the claim and resolving any balances due.
Why do I still have a balance if my insurance company pays 100% of Reasonable and Customary Charges?
Some insurance companies base payment on the average charges for all hospitals in a given area. This practice does not take into consideration the specialized nature of care at certain facilities managed by Cancer Treatment Centers of America and may not cover the full cost of the care you receive. You may be responsible for any balances. You are encouraged to discuss your coverage with your insurance company prior to treatment.
What are my payment options?
Since patients are financially liable for all medical services received, we offer alternatives for patients to pay their balances. The payment options may include cash, personal check, money order, credit cards and short-term payment plans. We accept Visa, Master Card and Discover. Should you have any open balances, you may be asked to pay them prior to further treatment.

It is exactly like everything else in life. You get what you pay for.