The health insurance industry controls patients, employers, and doctors by gaming the business of health benefits. Healthcare is an insurance industry monopoly that through scare tactics and misrepresentations has fooled everyone – including governments and the AMA (American Medical  Association) – to let them act as middlemen between patients and doctors. A level of control that has become abusive, costly, and failed to improve overall health.

Although health insurance was first designed to cover major or catastrophic care it slowly evolved to cover routine services. Highly unnecessary, the health insurance industry simply shifted costs for routine care to consumers through copays, deductibles, and non-covered services. Along with this prescription came anti-competitive mergers and self-serving healthcare laws that resulted in a massive consolidation of corporate power and erosion of patient, employer, and physician healthcare autonomy.

Two-thirds of the $3.6 trillion healthcare market is generally affordable routine office-based or outpatient care. Because the health insurance industry controls this care, billions of dollars are wasted each year on administration services in order for patients, employers, and doctors to play by health insurance rules.

How the health insurance industry controls patients.

  • Offers health plans that are complex by design and impossible to understand
  • Offer a variety of junk health plans
  • Offer confusing tiered plans such as bronze, silver, gold
  • Doctor networks with limited choices
  • Non-medical intermediaries working for health plans delaying, rationing or denying care
  • Calling innovative new treatments experimental and routinely denying them
  • Creating barriers to access by requiring referrals and authorizations for specialists, tests and treatments
  • Make you pay copays, deductibles and for non-covered services while the costly, rule-based health plan fails to kick in
  • Giving you endless surprise bills
  • Delivering health plan price hikes every year

How the health insurance industry controls employers.

  • Tiered pricing that is burdensome for small business employers
  • Confusing plan options
  • Held to insurance-based pricing and rules
  • Healthcare laws necessitate administrative and human resource costs
  • Pay more for health plans than employees commonly use in services

How the health insurance industry controls doctors.

  • Take it or leave it contracts
  • Created restrictive networks
  • Endless burdensome and self-serving rules
  • Severely discounted and delayed payments
  • Require endless hours pursuing authorizations from health plan non-medical intermediaries whose sole purpose is to delay, ration or deny care
  • Requiring malpractice insurance that mostly invites frivolous lawsuits and quick settlements
  • Tiered (and discriminatory) payments so doctors treating the same disease in different States or, within States get paid differently
  • Tiered payments so different specialists treating the same disease are paid differently
  • Bundling the costs for more than one procedure needed at time of surgery to one payment that is considerably less than if each had been provided separately
  • Require burdensome and expensive electronic medical records system
  • Require specialist office personnel to deal with complex medical coding and claims filing systems
  • Ability to claw back payments made within an 18 month period (despite authorizations)
  • By gaming, the business of healthcare, the health insurance industry has increased provider practice overhead to 70% and increased the level of physician burnout

It is simply amazing that the health insurance industry can hold patients, employers and doctors to ransom, profit at their expense and fail to improve overall health.

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 Written by HEALTHdrum