Many of us, particularly those who get their healthcare 'free' from an employer, take it for granted that the best coverage is the coverage that offers the closest to "first dollar" coverage, where we pay as little out-of-pocket as possible for our basic, non-hospitalized care. But is the 'best coverage' really better for you? This guide to insurance will present some views of health insurance (and health) that you may not get elsewhere, to help inform your own answer that personal question.
How your insurance company sees you: The dealer holds all the cards and makes the rules
Whether you pay for your own insurance totally by yourself, or your employer covers you, there are strategies out there to get yourself healthier and save money at the same time, but you have to know yourself and the system to take maximal advantage of them.
We have a range of choices for insurance, from no-out-of-pocket (NOOP), first-dollar (no deductible), no co-pay (your doctor visits covered 100% after you meet your deductible) coverage all the way to catastrophic insurance, where only the costs over $3,000, 5,000, or even 10,000 are covered. When we have NOOP coverage, or close to it, we have the illusion that 'they' are paying the bill. But without the thousands given to 'them' by us or our employers, (also 'us', because it ultimately reduces our paychecks), 'they' would not be able to provide these 'generous' benefits. If you choose to have higher deductibles and co-pays, many employers will give you a larger paycheck or take less out for insurance.
The bottom line first. Your insurance company is NOT quite your friend, whatever their promotional literature and big-bucks advertising indicates. They are a corporation, whose primary reason for being is profit. This is not to say that there is anything wrong with profit, it is just important to remember they are in business for the benefit of their stockholders first.
Even when the system works smoothly, we mustn't forget who invented the game that we are playing. The contracts that we sign were set up with teams of lawyers for the benefit of the insurance company, not us. They make the rules and have the power to decide how to follow them. If our claims are denied we have little recourse outside of begging and pleading, according to your contract. The laws that govern the insurance industry were set up, for the most part, by legislators with the help of lobbyists for the insurance companies and large donations to those legislators.
Insurance companies have to take in more than they pay out, or they wouldn't be in business. Even before their CEO gets his or her tens or hundreds of millions (even 1.7 Billion, in the case of William W. McGuire of United Healthcare) and other profits are doled out to shareholders, about 1/3 of what we pay them goes to administrative costs.
In many states, insurance companies can even cancel your policy or raise your premium if you get sick. Like in Vegas, you can't beat the house. Being that a family 4 generously gives them 10-14,000 per year, we give a lot of control to faceless companies for whom our best interests are not their primary goal.
Insurance companies relationship to your doctor
I have heard a report that one insurance company has a goal of reducing by 10% per year what it pays out for chiropractic care. Even if this is not true, insurance companies will lie to patients and doctors about what coverage they have, (they call it "oh sorry, I must have misread that"), lose claims, do repeated reviews, ask for money back for what they term as 'false billings' in which the doctor is guilty until they can prove their innocence. Drugs and surgery are covered, with little question on most policies, while exercise, nutritional supplements and therapies like chiropractic, acupuncture and rolfing, to name just a few, which work naturally to restore normal function are covered less, if at all. Practitioners of all types who may be doing innovative work are generally weeded out, as less personalized care becomes the norm because of greater time and paperwork pressures, and outright denial of anything that isn't 'by the book.'
Insurance companies bury healthcare providers of all types under a mountain of rules and paperwork. Each company has different requirements, and it has been estimated that up to 1/3 of doctor and staff time (read: money) is spent on paperwork for insurance.
To quote a pharmacist that I know, "the only people who are satisfied with their insurance company are those who are not sick."
Our relationship to them: no-out-of-pocket coverage tempts us act against our own best interests.
When someone else is paying the bill we tend to give up our personal initiative and judgment. I used to work as a chiropractor and acupuncturist at a facility with several medical doctors who would refer patients for chiropractic. Chiropractors, having little clout as a group, are at the rump-end of the insurance business; we get paid by insurance only as an afterthought on many policies, if at all, and regularly have claims denied or reduced for little or no reason. Many times where I worked, patients would come in to see the medical doctor who would refer them to me, but their insurance wouldn't cover my services. Most of those patients would not come to see me. They actually chose to stay in pain rather than pay to be healthy!
While we don't intend it, insurance that covers most of our healthcare herds us towards certain types of healthcare and certain doctors, and un-natural ways of thinking about health, sapping our own initiative and feeling of control and responsibility for our own health. We may (understandably) feel entitled to the free services that we have spent so much on, and understandably don't want to take any more out of our pockets. Psychologically, it is hard to resist the feeling that we have a guarantee on our lives; if we're broken, we'll just get ourselves fixed. We're covered, like a warranty on our cars computers.
In part 2 of this article, we will look at how we can best satisfy the needs and goals of insurance and health.
Dr. Robert Weissfeld is a chiropractor in private practice in Denver, CO. In various health fields since 1976, and with certifications in acupuncture and neural therapy, and experience or training kinesiology in nutrition, herbology, yoga, meditation and transpersonal psychology, Dr. Weissfeld has researched and developed new understandings and methodologies of healing. He uses a method called NeurOntogenics-tm. The nervous system is like a (Windows, not Mac) computer, whose loaded programs reside in memory and cause the computer to slow down and even fail if you don't reboot.
The nervous system creates, on-the-fly, muscular, mental, emotional and biochemical 'programs' to deal with the stresses and traumas of life. These adaptive or compensatory programs, useful in the short run, may not be useful in other situations. Tthey remain loaded, as it were, and are a generally overlooked cause of much of the physical and emotional pain we experience, and contribute to a greater or lesser degree, to organ and glandular dysfunction.
NeurOntogenics-tm literally erases outdated adaptive programs to 'reboot' (restore) fundamental, pre-stress and pre-trauma function. It specifically targets the areas that you want to restore to a 'clean boot' of harmonious operation. Guided by muscle testing, it applies specific natural, usually rapid and painless treatments to restore normal function by erasing unneeded function. When function is restored, dysfunction, pain and tension of any physical, mental or emotional area of life can disappear immediately, because the driving force (learned patterns of adaptation) has been eliminated.
You can find out more about how this works from the perspective of the brain, and how it can help in various conditions at http://NeurOntogenics.com
