I've worked in the health insurance business for twenty-three years. To all who would listen I've enthused about annual deductibles, office visit co-pays, and routine gynecological exams. The mere mention of out-of-pocket-maximums brought tears to my eyes. I proudly stood against the hordes that were clamoring for socialized medicine and declared that our health care system was the best in the world.
I believed that if you had health insurance in this country, you had access to the very best medical care. We lead the entire world in the development of new treatments and technologies precisely because we don't have socialized medicine and are willing to pay for groundbreaking discoveries. Botox was invented in the US, as was the silicone breast implant, and the most common type of liposuction, to name just some of the more important discoveries. I ask you, where would half the Hollywood actresses be today without good old American health care?
But, alas, it's all for naught, because I'm giving up the fight.
What has caused this about-face? The answer is weariness. This little health insurance war has been going on for some twenty years. I know England and France had their Hundred Years? War, and we're not quite in their league, but at least they had those little things called ?victories? and ?defeats.? What do we have? One horrendous scrum which never ends. For two decades there has been incessant political posturing and legislative skirmishes. Nothing changed. Fifteen years ago there was the epic called Hilliarycare. Nothing changed. Most recently we unleashed the secret weapon that would decisively end the health insurance war forever: Arnold Swartzenegger. Nothing changed.
He promised to bash heads until every individual and family in California had affordable health insurance. Instead the most buff bureaucrat in all the land went down like a Bavarian girlie man in lederhosen.
That was the final blow. I'm finished. In the words of that famous boxer of yesteryear who was getting his butt kicked, I say ?no mas.?
As of today I renounce my past affiliations and proclaim my allegiance to a new master: socialized medicine. As a token of my sincerity I will perform the following deeds: I will hang a picture of Nancy Pelosi in my office; I will lay a wreath at the tomb of Karl Marx; I will move to Massachusetts; and I will listen to Woody Guthrie music for 30 days.
I don't care about the tens of thousands of lives that have been saved because we have resisted the beguiling allure of socialized medicine. I want peace. I want the blissful peace of a Brit who, when asked how much he pays for health insurance, innocently proclaims ?We don't pay anything, it's free!? I don't care if you raise my taxes so high it makes Ted Kennedy giggle like a drunken debutante. I just want to say I've got ?free? health insurance.
Besides, everybody always says we Americans know how to stand in line. That means socialized medicine is perfect for us. Just show us where the line is for heart bypass surgery and we'll stand there till kingdom come. We'll show those smiley faced, polite Canadians who are always jumping out of their socialized surgery line and coming down here for their operations.
I'm dreaming of the day when the fighting is over and I can look my Cuban comrades in the eye and proudly hold up my socialized medical card and say ?See! You're not the only ones who have lousy health care. We have it too, every damned one of us!?
Health Insurance For Graduates
Many people have the idea that managed healthcare, meaning a health maintenance organization (HMO), preferred provider organization (PPO), or point-of-service plan (POS), is an affordable form of the old fee-for-service system, but with more paperwork and perhaps more insurance company "meddling."
People need to realize that this is a whole new system, a binding legal contract, with strict limitations, says Paula Mikrut, MD, vice president of medical affairs of Intergroup of Arizona, a medium-sized HMO with 350,000 members.
When you sign up with an HMO, you are signing a contract saying you will abide by the rules of the road and will receive only covered benefits. Not all tests, all treatments, all drugs, all doctors in town will be covered. This is a fact of life under managed care.
MAKE THE SYSTEM WORK FOR YOU
The first thing you can do to maximize what you get from your health plan is to choose a plan wisely. If your employer offers no choices, the following tips are even more important. If you do have a choice, it is up to you to check out the plans and see if they meet your particular needs.
The National Committee for Quality Assurance (NCQA) in Washington rates plans by a number of criteria, including access to doctors, quality of physicians, wellness and disease management programs in place (including how many people get recommended tests), and how plans treat people during and after an episode of injury or illness. Ratings can be accessed on the Web site (www.ncqa.org). Employers use this information to decide what plans to offer. You should use it to decide which plan to choose.
You can choose a plan that includes your favorite doctors, or you can choose a "primary care physician" after you get in the plan. That doctor is your key to the system, although primaries are often called "gatekeepers," which has a connotation of a closing gate, in some cases denying you treatment or regulating what specialists you can see.
In reality, your primary can be your advocate and help you negotiate the system. The problem is that your doctor may be "serving" many different plans, with different sets of rules, and may need help to get you a good result. That's where you come in.
READ THE BOOK
The first thing you need to do (really, don't wince) is read your Evidence of Coverage booklet. This is your insurance policy: It tells you what your health plan will cover and what it will not. You need to know what hospitals you can go or be taken to, what labs will do your tests, when you can call an ambulance, what to do if you get sick on weekends, what home care will be allowed, what medical devices such as wheelchairs are paid for, and dozens of other important things.
"It's only human to ignore conditions until they become urgent," Dr. Mikrut says. "Many people don't pick a primary until it's 3 in the morning and they're sick. But you have a diminished ability to deal with your health plan under such conditions."
KEEP YOUR OWN MEDICAL RECORDS
"File health insurance records just like you would keep all the tax records for your house," advises Mikrut. "If you keep immunization records for child, keep a chronology of significant health events and doctors' visits for everyone in your household -- adults too. Know when you had your last tetanus shot, your last mammogram." Although many plans will send you reminders of needed visits, ultimately it's your job to make your own appointments.
Unless you have "open referral," your primary must recommend and approve a visit to a specialist. Most plans allow such visits if medically reasonable, and almost all will allow a paid second opinion.
As for pharmacy, as everyone knows by now, each managed care company has a "formulary" of approved drugs. If you take a medicine "off the formulary" or a brand name, you will probably pay more. Talk to your doctor, and ask about alternative medicines that are on the formulary. Some plans, including Intergroup, issue a booklet to patients with all the drugs on the formulary: Hand it to your doctor and discuss selections.
Both Tim Patrick & Quinto Romero are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
Quinto Romero has sinced written about articles on various topics from Cosmetic Surgery, Acid Reflux and Health Insurance. Health Search Online is a health and medical resource that offers information on topics such as medications, diseases, healthy living, and more. To learn more abo. Quinto Romero's top article generates over 1900 views. Bookmark Quinto Romero to your Favourites.
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