How Insurance Works (it may surprise you)

Do you know how insurance works?

We are brought up to believe it is a good thing.  Something we cannot live without.  Something that is so essential that it is immoral to live without it.  Something we must give the poor, who cannot afford it.

It is our guardian angle.  It is that unseen element that will pay our expensive doctor bills if we get sick.  It will make us better.  It will make us strong and pure.  To show our benevolent spirit, we must ensure everyone has it, even if we do it with the force of law.  Arrest and fine those that dare to disagree!  They deserve punishment!

Oh, and those evil doctors.  You know, they are the arch nemesis of the pure insurance companies.  They are so evil they CHARGE the insurance companies, yes, the BENEVOLENT insurance companies, MONEY for their services! Can you believe that?  It is like stealing from the oppressed! BAD, BAD, DOCTORS.

Your dear president Obama even gave examples of how the evil doctors often do unnecessary surgery, just to make money.  He said a doctor would “rather amputate a foot for $20,000 than to treat the diabetes”.  Yes, he said that.  Because he also knows the doctors are evil.

But I digress.  This is how the brainwashing happened.  So how does insurance work?

You pay a premium.  That is your monthly payment.  The insurance company takes that premium, and invest it.  They hope you do not get sick, but  if you do get sick, they will pay your bills.  Why do we need this?  Because the bills are more expensive than your premiums paid.  All you have to do is look at your medical bills.  Or so they say….

What you are not being told is that you are being deceived.

That bill you get from the doctor’s office does not reflect the amount the doctor is being paid for their service.  Not even close.

Here is an example.  You cough, and go see your doctor.  The doctor prescribes a chest x-ray.  You comply, and go home.  The next day, your doctor calls and says the radiologist report came in,  you are fine, get some rest, come see me again.

A month later, you get a bill for $1,200 for the chest x-ray.  However, since you had insurance, you only have to pay $100 co-pay.  You think, “man, I am glad I have insurance.  I saved $1,100”.  That is because you are duped.

The truth is, you paid the insurance company $100 for this service.  The insurance company paid the doctor, wait for it, $28.00 or less.  Yes, you read that right.  The doctor was reimbursed about 25% of your copay.  The insurance company profited about 75%, just off your copay.  Your premium, my friend, is purchasing their skyscraper.

This payment from the insurance company is broken into two parts, a technical fee, and a professional fee.  Often, the doctor gets the professional fee, and the technical fee goes to the center.

Why is the bill so high, you ask.  It is because of Medicare Regulations.  You see, if Medicare pays a fee for a service at a given amount, say $30, (and the business takes Medicare payments), the business can never charge less than $30 for that service.  If they do charge less, it is called “Medicare Fraud”, and the proprietor will go to jail.  (Obama will pardon a drug dealer to make room for them in the prison).  To be safe, small healthcare practices generally double the amount Medicare pays for any service, and start their negotiations with insurance companies at that level.  This is called the “law of unintended consequences”, and is another example of how Uncle Sam is driving up health care costs.

For homework, research CPT codes, reimbursement schedule, 2016.  You may be surprised.  You might even blog nasty things about a democrat….

What really happened to our insurance

For years, I have purchased my own insurance.  After the Affordable (?)Healthcare Act, I was forced by our government to purchase healthcare plans that support abortions, pregnancy, pre-existing conditions, etc.  These additional items drove up the costs, naturally.  (Lest we forget, NO republican voted for this).

Still, I was not prepared for the high deductible.  I had not had a high deductible for years, because of the insurance plans I chose to purchase.  Those plans are now considered “Cadillac plans” AND ARE TAXED AS INCOME!  My deductible is more expensive than the amount of insurance normally spent on my entire family over the course of a year.  Now, in essence, ALL OF MY HEALTH COSTS ARE OUT OF POCKET! 

To provide an example:  I was spending $13,000 annually for insurance coverage.  I had no deductible, and almost all medical bills were covered, so in essence, my healthcare cost were capped at $13,000.

I now pay $15,000 annually for insurance.  However, my deductible is $10,000.  My healthcare costs are now $25,000 annually.  But the worst news is, they are not capped.  I am only covered at 80% of the cost of medical expenses, leaving me exposed for the other 20%.  I also am paying high copays for things that are covered.

What has happened is, in effect, ObamaCare has erased health insurance for me.  The insurance companies are getting a free ride, at my expense.  I am paying them a premium, and my premium exceeds the amount they are spending on me for healthcare.  I would save money dropping the plans.  I would drop them, but it is a FEDERAL LAW that I purchase it.

The working middle class is getting robbed by this plan.

Where does the money go?  Yesterday, the back of the plane I was travelling on was filled with immigrants that came into the country illegally.  They were being flown to Atlanta, for “free” health care.

Thanks again, Democrats.  You have found another way to purchase new voters and steal the payment from the money I earned.  I bet your parents weren’t married….