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Tuesday, Jan. 17, 2017

Insurance: Help or horror

Posted Monday, December 17, 2007, at 7:11 AM

As a sinkhole continued to threaten the Blue Ribbon Parkway home of Margaret Little last week, one of her main concerns was what she described as her insurance company's insistence that the danger could be eliminated.

I'm no expert on sinkholes, but Little's concern is understandable. Seems like that sinkhole would, if filled in like she says the insurance company wants, just re-form.

But, in too many cases, what the insurance company wants, the insurance company gets. I realize some people try to cheat those companies, but too many honest people are being hurt and/or shortchanged.

I'm sure many of you have horror stories of insurance companies refusing to pay, or paying less than they should have, on claims involving long-time customers.

And we've heard too many stories over the past few years of long-term customers being cancelled after a single claim.

I'm normally not in favor of heavy government intervention, but maybe Congress needs to take a long look at the practices of some insurance companies.

On a related note:

The Tennessean's editorial page this morning concerns the continually-rising cost of health insurance and how employers, unions (when applicable) and individuals are shouldering more and more of the cost. And they say, without specifically saying how, that health care costs in general need to stabilize.

One guest columnist says individuals, expecially the two-thirds of Americans who are overweight, are partially to blame for rising insurance costs. I thought that was sort of a cheap shot at individuals.

Actually, sharing the blame are profit-hungry insurance companies themselves; drug firms; hospitals, which face rising costs while investors expect ever-larger dividends; and lawyers and individuals ready to sue at the drop of a pin. Add to the mix executives for whom dollars are the only thing that matters.

Some may say physicians themselves charge too much. But it seems to me that they're forced into situations where they have to raise treatment prices because of ever-rising costs due largely to the other reasons mentioned above, especially the legal aspect.

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I will have to say horror. I don't see how they (the insurance companies) can blame obese people. The idea is absurd, especially when I was in the hospital and they charged me $18.75 for a tylenol. Just one tylenol. I could have bought several hundred at Wal-mart for that price. Seems to me, they need to start blaming the hospitals.

and $75.00 a month for a doctor to write me a prescripton that the pharmacist said could easily have refills on it...sounds like I am getting ripped off. Makes me wonder how many other people and insurance companies pay that every month for her to scribble a few words on a piece of paper? Half the time I don't even see her, the secretary just hands me the prescription after I have paid the money and waited for over an hour in the waiting room. This has been going on for over 4 years now.

-- Posted by Disturbia on Mon, Dec 17, 2007, at 8:53 AM

Disturbia you need to find a new Dr. Thats crazy!

Some people are obese DUE to health problems, that was a low blow.

The house should be condemned and the owner should receive fair market value of the home from the insurance company. Doubt that will ever happen!

-- Posted by Disgusted on Mon, Dec 17, 2007, at 10:12 AM


279.00 per month premium

30.00 office call co-pay

15.00 generic drug co-pay

25.00 non-generic co pay

$2000.00 major medical deductible per year

Every time I go to the Doctor I am wondering why is it when someone has no insurance a office call is $50.00 but if I have insurance the same office call is $75.00 is that because if they charged the insurance company only $50.00 I would be paying more than half of the visit?

Generic Drugs are cheaper at Wal-Mart at $4.00 per generic prescription than my co-pay.

I have yet to Ever use my Major Medical. But I still pay $279.00 per month for my premiums. That's $3348.00 per year I am paying just in premiums not counting my doctor's office calls and prescriptions.

The only upside I see is being able to use this as a tax deduction on my out of pocket expenses. Which is great as long as you have more deductions than the amount of the standard deduction.

-- Posted by donna37160 on Mon, Dec 17, 2007, at 10:29 AM

Way back when,automatic prescriptions were curtailed so people would have to come back in and get re-evaluated.

New developments in their condition,new treatment options,etc. would all warrant regular visits with the doctor.

Now,it seems as if all this lack of automatic refills accomplishes is delaying the patients getting necessary medication and giving the doctor a stack of orders to call in to the pharmacies every day.

Such a system runs the risk of being just as much 'by rote' as if a computer at the drug store automatically filled up a little bottle with thirty pills every month unless programmed otherwise.

The difference being the cost,the potential for dangerous delays in getting the meds replenished and the illusion that the patient is getting more attention.

There needs to be far more history-taking,co-operation among patients and providers and follow-up and a lot fewer doctor's visits that accomplish little more than an exchange of cash and germs.

A high fee for effective therapy and good practioners is money well spent but a lack of wellness care,scant and impersonal treatment and reams of red tape are frustratingly unproductive for medical professionals,their clients,the families and even the insurance companies.

As for the legal expenses,the competent,caring providers and truly needy patients are getting ripped off while the rest continue to bilk the system with little or no inconvenience.

I'm not sure how this would be accomplished but an adequate amount of efficiency and accountability would be worth the price.

(But,what do you want to bet that real health care would be cheaper and more profitable for all concerned?)

-- Posted by quantumcat on Tue, Dec 18, 2007, at 2:08 PM

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David Melson is a copy editor and staff writer for the Times-Gazette.