The Basic Problem with Health Insurance
If you buy a bigger house or a more expensive car then someone else, you expect to pay more for the associated insurance because your risk is bigger.
However, if you eat 2 cheeseburgers and pounds of fries every day, you pay the same rate for health insurance as your friend who only eats organic foods and rigorously manages their nutrition. Even if you don’t buy into the science of nutrition, the health benefits of moderate exercise are unassailable. You exercise 4 to 6 times per week, your friend doesn’t, you pay the same rate. Your friend is much more likely to need significant medical treatment and is a much higher risk from an underwriting perspective. It doesn’t matter. The system is broken.
Health Insurance Companies React
In the United States, most people get their health insurance through their employer. It’s a material part of most employee’s total compensation. However, an increasing number of employees are being forced into High-deductible plans where they must pay at least the first $1000 of their care in addition to the insurance premium. This makes the employee, essentially, a cash payer for their healthcare as most people don’t consume enough healthcare services in a year to meet their deductible. That’s why it’s especially galling that some health insurers are starting to deny Emergency Room claims for procedures they don’t deem to be emergencies (See Article). This practice is absurd because there is no way for an employee to know if their procedure would be covered in advance. If you think you’re having a heart attack, it’s not realistic of you to take the time to call your insurance company and ask them if, based on your symptoms, they reasonably think you are. Then, when you get the ER bill for $8,000 and it turns out to just be indigestion, you have to wonder if you’re covered.
What Can You Do
If you find yourself in the unfortunate situation of having a plan with uncertain coverage, get informed. Take the time to clearly understand what’s covered and what’s not covered so you can make decisions with your eyes wide open. Then, learn to shop for healthcare. Healthcare Bluebook provides the fair price for most common procedures everywhere in the United States. You can use Healthcare Bluebook to negotiate with your provider or to help find a provider that will accept the fair price. Think of it this way. If you need to purchase anew television ($400-800), you’re going to spend several hours talking to people about their television experience and researching televisions online. If you have knee pain and are headed to the orthopedist ($300 for office visits, $100 for X-ray, $800 for MRI plus potentially $4,500 for a knee scope) isn’t it worth at least the same amount of shopping time as you would spend for a television?
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