6 posts tagged “insurance”
I have hated insurance since as far back as I can remember. To me, it seemed like a legitimized mafia practice. Pay me in case something bad happens. Oh, and if something bad does happen, good luck getting us to do anything about it! I hate insurance because it has changed the medical industry as well. Medicine is now practiced based upon the bottom line rather than the care of patients. Costs have skyrocketed because hospitals know that they can get the money from insurance companies rather than patients. If you are a patient and you have a severe illness, you can't expect to be treated unless you demonstrate the ability to pay. Do you know what really hammers this idea home? Should you get really sick, insurance companies will ACTIVELY seek to remove you so that they don't have to pay out! This practice is acknowledged by our government:
The Department of Health and Human Services put a spotlight on that practice Tuesday in its continuing campaign to build support for an overhaul of health insurance.
“When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire,” the HHS said in a posting at HealthReform.Gov. In most states, insurance companies can retroactively cancel individuals' policies if any condition was not disclosed when the policy was obtained, "even if the medical condition is unrelated, and even if the person was not aware of the condition at the time.”
“Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition,” HHS said.
The department cited recent research by the staff of the House Committee on Energy and Commerce, which found that three large insurers rescinded almost 20,000 policies over five years, saving $300 million in medical claims.
“Simply put, these insurance company employees are encouraged to revoke sick people’s health coverage," HHS said.
Do you want to know the lengths to which they will go? I will offer you two examples, one which would seem obvious given what these corrupt assholes are doing, and the other that should terrify any clear-thinking person.
WellPoint and Assurant told the committee that they automatically investigate the medical records of every policyholder with certain conditions, including leukemia, ovarian cancer, brain cancer, and becoming pregnant with twins, the committee staff wrote.
In November 2006, after a Texas resident was found to have a lump in her breast, Wellpoint investigated her medical history and concluded that she had been diagnosed previously with osteoporosis. The insurer rescinded her policy and refused to pay for treatment of the lump, the committee staff wrote.
Under the current system, something as relatively simple as seasonal sneezing can jeopardize your financial security, HHS argues, citing a 2001 study for the Kaiser Family Foundation.
“Even when offering coverage, insurers can exclude whole categories of illnesses related to a preexisting condition. For example, someone with a preexisting condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage,” HHS said.
In a truly disgusting practice, it was revealed that Blue Cross REWARDS their employees for dropping policy holders who become ill with anything serious:
But documents obtained by the House Committee on Energy and Commerce and released today show that the company's employee performance evaluation program did include a review of rescission activity.
The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.
WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.
What is the bottom line on all this? The bottom line is that it is all about the bottom line for insurance companies. They will gladly take your premiums, but when it comes time to honor their obligations, they will find a way out of them. It is a truly disgusting practice, but I believe it to be systematic of how things in our country operate in our modern age. It becomes increasingly difficult to believe that the rich and powerful don't run this country in a manner that only fosters their own interests. I firmly believe that the average citizen has no say in our government anymore.
Well, my good buddy, Steve Jobs, (NOT! I hate the man...) recently emerged from a liver transplant procedure and he is doing very well all things considered. While I hate the man with a passion that can't be comprehended by mortals, even I will admit that I am glad that he is doing well. I know that going through such a thing is hell, its risky, and it can destroy a person. I know that many people aren't aware of how the organ transplant process works in how it finds and matches donors, so I figured that I would shine some light on this subject.
Livers are a scarce resource. In any given year, only about one-third of the people on the national transplant waiting list receive one, and as of late June, more than 16,000 people were on the list.
Yet it sometimes seems that celebrities in need end up at the front of the line when they need a transplant, and people often assume they get preferential treatment. (Rumors about special treatment circulated after baseball player Mickey Mantle's liver transplant in 1995, for example.)
The truth is more complicated. No one can actually buy an organ in the United States (legally, that is). But getting a liver transplant, it turns out, is a lot like getting into college. Once you're on the waiting list, your chances of getting off it depend largely on your personal circumstances -- how sick you are and whether you are a good donor match. But getting on the list in the first place -- or on more than one list, as the case may be -- requires resources and know-how that most people don't have.
There are 127 centers in the U.S. that perform liver transplants. If you need an organ transplant, your doctor will refer you to one of these centers, where you will be evaluated, given a score based on the severity of illness, and placed on the center's waiting list, if you are indeed a candidate for transplant.
The center's waiting list feeds into a national database managed by the United Network for Organ Sharing (UNOS), a nonprofit organization that contracts with the federal government to manage the nation's organ transplant system.
UNOS works with 58 organ procurement organizations (OPOs) that coordinate organ distribution in their region of the country. When an organ becomes available, the OPO in that region searches the UNOS database for a local match using blood type (and other biological considerations), the patient's severity score, and the time spent on the waiting list. If a match can't be made within that region, the organization expands its search to neighboring regions.
The problem -- or the advantage for some patients -- is that not all OPOs are created equal. Some regions contain nearly 15 times as many people as others, and their waiting list times vary widely. Patients in the smaller OPOs tend to be less sick and experience shorter wait times before getting an organ. In the Tennessee OPO where Jobs received his transplant, the median wait for a liver between 2002 and 2007 was just over four months. The national average was just over a year, and in some OPOs it was more than three years.
Though there is always the possibility of preferential treatment once a patient is on a waiting list -- UNOS conducts periodic audits of transplant centers for exactly this reason -- it is unlikely that someone like Steve Jobs can "cut the line" of the transplant waiting list.
The reason that some people might be able to get transplants more quickly is that they're standing in more lines. Nothing prevents someone from being evaluated and listed at multiple transplant centers. As long as a patient has the wherewithal to fly around the country -- and be available at the drop of a hat if a liver becomes available (this is where the private jet comes in handy) -- a patient can, in theory, be evaluated by all the transplant centers in the country.
"The system works at two levels," explains Arthur Caplan, Ph.D., the chair of the department of medical ethics at the University of Pennsylvania. "One, who gets in to a center. Two, who gets transplanted off a particular center's list when an organ becomes available. Most of the attention goes to stage two, but the biggest ethical challenges are really at stage one."
Since 2003, UNOS has required that transplant centers inform all candidates that they can be evaluated and listed at more than one center, and that they can also transfer their care from one center to another without losing the time they have accrued on the waiting list. However, not everyone can afford to fly around the country and be evaluated at more than one transplant center. In fact, many people can't afford a liver transplant, period.
According to the most recent estimates, the cost of a liver transplant is $519,600 -- a price tag that excludes roughly one-third of Americans because they don't have sufficient insurance (or any insurance), Caplan estimates. According to data collected for UNOS, only about 5 percent of liver transplants are paid for out of pocket.
"What your insurance covers is very different from everyone else's," says Anne Paschke, a spokesperson for UNOS. Some insurance companies won't cover evaluations at multiple transplant centers, Paschke explains, and in at least one case, an insurance company has restricted its coverage to a single transplant center that the company itself owned.
Obviously, the system is flawed and favors those with the means to work the system. There have been attempts to reform the system, but they have all met their end in Congress. Politicking has left the larger transplant centers against the smaller ones. The larger ones wish to maintain the larger pool of available organs in their region, whereas the smaller ones were concerned that in a national organ allocation system, they would receive fewer transplants and be driven out of business.
There is work to be done in this area. No matter what side you fall on.
Source: CNN Health
Source: Health.com: The real gift of life: How medical donations help
Talking about health issues is tough for anyone. It is especially tough for me, for personal reasons. I won't espouse about any recent goings-on, but I will lament the experience afterward. I think that by and large, the medical community has changed from an entity that's purpose was to provide the best possible care to its patients, to a business that is more concerned with maintaining relationships with insurance companies, the government agencies that pay out claims, and the bottom line. (Jesus, this is horrible. But it's 3:30 A.M...)
I am not an idiot, and I am perfectly aware that hospitals have to make a profit. I am with them on that front. I contend that the real problem is the insurance industry. With the advent of medical insurance, costs have risen at a very healthy rate for many, many years. While I find the entire concept flawed, I will play devil's advocate here for a second. In theory, you pay an insurance premium every month as protection against some catastrophic illness or accident. Should such a thing occur, you pay a deductible, and the insurance company pays the remainder. In practice, it NEVER works this way. In practice, you pay a premium that rises astronomically if you have ever been very ill/hurt, your deductible is an enormous amount, and the insurance company pays only X% of the costs. The problem is that if you have to have heart surgery, and the cost of the operation is $225,000 and your deductible is $1000 (if you are lucky), your insurance will likely pay either 70/80% of the cost. So what does that translate to? How about $46,000 out of your pocket not accounting for any costs post-op. I know that there are some people who can afford this, but the reality is that the vast majority of Americans cannot afford such things. At this point, the person or family is left facing an unpayable medical debt either way. What is the way out? Bankruptcy. Over 60% of U.S bankruptcies are attributable to medical debt. Ask yourself what the real difference is between a $225,000 debt and a $45,000 one. It's likely that you wouldn't be able to afford either one.
It gets worse too. The people whom are all-too-happy to take our money are rather stingy when it comes time to pay out. Consider the recent discovery that health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee.
At a committee hearing yesterday, three health-care specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that do not cover needed care. Rockefeller said he was exploring "why consumers get such a raw deal from their insurance companies."
The star witness at the hearing was a former public relations executive for major health insurers whose testimony boiled down to this: Don't trust the insurers.
"The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent and accountable -- publicly accountable -- health-care option," said Wendell Potter, who until early last year was vice president for corporate communications at the big insurer Cigna.
Potter said he worries "that the industry's charm offensive, which is the most visible part of duplicitous and well-financed PR and lobbying campaigns, may well shape reform in a way that benefits Wall Street far more than average Americans."
Insurers make paperwork confusing because "they realize that people will just simply give up and not pursue it" if they think they have been shortchanged, Potter said.
The report released yesterday alleges that insurers have systematically underpaid for out-of-network care. The issue had been brought to light previously in litigation, committee hearings and other investigations, including a probe by New York Attorney General Andrew M. Cuomo. But as politicians and interests groups clash over the current effort to overhaul the nation's health-care system, it took on new relevance.
Cuomo described it last year as "a scheme by health insurers to defraud consumers by manipulating reimbursement rates."
Cuomo found that insurers under-reimbursed New York consumers by up to 28 percent, the report said.
Wash Post: Senate Hears of a Raw Deal
In an upcoming post, I will discuss Obama's health care initiative and see what it does-and doesn't-do to solve some of these issues. And in a follow-up post, I will analyze how the organ transplant process works as it pertains to patients and those with significant financial means.
I have never been a fan of Gamestop per se, as I believe (along with Dave Halverson-You ROCK Dave!) it cannibalizes the industry. I had a hard time believing the hype, until one came to my area. Most of the gamers that I know (the ones who just play games and don't follow the industry) go there on a regular basis and purchase their games there. This is all well and good, if Gamestop only sold new games. They sell used games, however, and that is what everyone that I know has been buying.
First off, I wonder why they bother. They only save $10 to $15 per game. This also happens to be roughly the same amount that goes to the developer when a boxed copy game is sold at retail. Secondly, I don't know why anyone would want to support them. The point of this rant was my experience there last night. I had purchased an extra copy of Bioshock and The Darkness for my brother as a gift. This was a couple of months ago, and my brother never played either one and he gave them back to me. Since I already had both games, I was stuck with the extra copies. Normally, I would offer them to a friend, but since this is gaming primetime, I figured I might try the trade-in thing (yes-the very thing that I deplore!-the economy sucks...) and put the money towards Far Cry 2 or Fable II. To make a long story short, for Bioshock and The Darkness I was given $10. I don't care about the money, but its the process that enrages me.
Think about this for a second. Gamestop sells a new game for $60. They give $5 for trade in. They then proceed to sell your $5 used game for $45 or $50. The reason that they are so profitable is that they make $40 to $45 per game! Walmart wishes that they had that kind of margin!
The problem that I have with this scenario is this: At retail, a game developer can expect to make $10-$15 per game. The publisher makes some money as well. It is important to fund the developer as they make the game and a lack of profits forces the publishers to coerce developers into making more homogenized games. Look at all of the derivitave games out there! In the Gamestop model, a developer only makes $15 on 5 games for example vs. $50 to $75 at retail! I hate it, and I wish that gamers would wisen up. I am for the download model for this reason alone. Nothing against the store (I love games, and at least 30% of gamers-who couldn't love a store devoted to that?), but that process is the definition of cannibalization.
Other Thoughts
I am sitting here, typing the above and an MSN alert pops up saying that the government bailout is spreading to the insurance industries! That is absurd! An extortion industry (think about it-pay me in case something happens. Doesn't that sound like what they prosecute the mafia for?) that has created and expanded several industries and is largely responsible for out of control health-care costs is being bailed out with our money! I HATE the leaders of our country. There truly isn't a good politician living or working in the United States.
I am also troubled by the news of Jennifer Hudsons family! I don't follow her that much, but I like her music and the fact that she came from a bad place and made something of herself through capitalizing on her talent. I am truly sorry for her and send my condolences.
One last thing has been on my mind. I mean that as an undercurrent as there are alot of things on my mind (yeah, Ashley! Thanks for not paying the fucking fireplace bill the whole year you lived here! What the fuck did you do with all that money!?). I have been getting the feeling that I am drifting away from her. While I may play it off, or play stupid alot of the time, that is rarely the case. I can't deny that this is the feeling that I have been getting. You know, how when someone likes you, they consume you? I mean that they can't seem to get enough of you? That feeling hasn't been happening lately. It has begun to feel as if I am an afterthought. This all may be inane contemplations on my part. One of the real issues is that I feel completely useless to her. She is having a hard time with something, and I can't help her. I don't know enough about her, and that upsets me. I feel so powerless. I can't get her to let me in to any of these matters, and its things like that that fuel my thoughts that I am drifting away. I digress...
While it would appear that I have abandoned Vox since the fire; that is not entirely true. There has been so much that has happened since then but I have been completely overwhelmed. I don’t want to bore anyone with the details I will break it down in categories:
Insurance
First of all, let me say that it is nothing like the commercials would have you believe. Setting aside my belief that insurance is the biggest scam in the history of mankind, I have to say that insurance is the biggest scam in the history of mankind. The notion of paying for something in the event that something should happen seems very reminiscent of the extortion conducted by the Mafia back in the day. Sadly costs have risen so drastically that is impossible for anyone to make it without insurance. It is my opinion however that if insurance hadn’t taken off, costs would have risen at a much more gradual pace.
I main concern is after turning in over $450,000 of property, I was cut a check for $78,000. To make matters worse, it wasn’t a simple process involved enough harassing $78,000 for that in and of itself. It’s a terrible thing to have to start over, but it’s even worse in instances like this.
Housing
Luckily things are coming along well with the house. Naturally, things are behind schedule, but otherwise they are going quite well. Stay tuned sometime within the next week I’ll have some pics up of the house and its progress.
Work
Because of what happened with the insurance company, my life has taken a drastic change in this department. And it is very much not for the better! I now work three jobs in an effort to shore up the shortcomings of the insurance company. I have been averaging 104 hours a week. This has had many negative impacts on my life (to be detailed below), and has greatly affected my feelings towards my jobs. I currently am very dissatisfied at work. It isn’t necessarily the jobs themselves however, it is more likely the fact that I have no break…no rest…no sleep. And no outlet for stress…
Life
The changes that the fire has wrought have had such a drastic impact on my life. The stress of the situation…the sacrifices made…the need to work all the time…the millions of other things have all combined to break up my relationship. So what some of you say? I have had a few long term relationships, but this one was different. It was this relationship that made me realize that I didn’t love those other women-I cared about them-but I didn’t love them. But I won’t go down that road at this time. *sigh*
The stress of me working all the time has also made it really hard to enjoy anything. The majority of my friends bailed. I think that a lot of them didn’t know what to do or say, so I don’t necessarily blame them. But life sure has gotten much harder.
However, I don’t want to have everyone thinking that it is all doom and gloom. One very positive thing has happened. I have enrolled back in school. I started full time, but I realized that I had to work some more to get up to speed, so now I go half-time. I am back at DeVry and should be done in the spring. And despite my schedule (and the fact that I am currently a zombie…viva la Halloween!), I am doing very well. A’s all the way! Well it is 4 AM, and I need to study…I will be back to my regular updates from this point on.
Thank you everyone for your condolences.
So, the house is destroyed. There is not much left, and the cleanup has been a real PITA. The weather has not been cooperating-it has been cold and snowing/raining-followed by a day or two of warm weather (on the days that I have to work...)-so it hasn't been much fun. What we are able to dig through is both damaged by the fire and the water/foam that they used to put it out.
I can't lie. It has been more emotional than I thought it would be. I didn't realize how much some of that stuff meant to me. For example: The burial flag of my biological father. I only met him one time, but it was all that I had of him.
And on the other hand, I didn't realize how MUCH stuff I had. Jesus! I guess a person really accumulates alot of things during their years...
And one last note that has been a real thorn in my side is the forms that the insurance company requires me to fill out. I need to have pics, know the names, model numbers/serial numbers of the items, where I bought them, how much I paid, when I bought them, and the value that they currently sell for. Seriously, what the fuck work are they doing? Obviously, they make it so hard in the hopes that people aren't able to come up with all of the information so they don't have to pay the full policy value. Fricking jerks...
