AboutLinda Woolsteen Expertise I can help you with questions about health insurance. If you feel your insurance company is mistreating you. Are they telling you they are checking eligibity, pre-existing, etc. Or you just don`t understand how your insurance works or don`t understand what a PPO is.. I can help you.
Experience
Past/Present clients One company I worked for I was the underwriter for the Academy of Medicine of Cleveland and the Ohio Bar Association. I was also a supervisor of our customer service department.
Question Hi, my name is Baris. Would you please tell me about the problems that health industry faces because of the current economic crisis. Many thanks in advance. Best Regards, Baris Unal.
Answer Hi, Well I do not think I can subjectivly answer that question because I am no longer working in the Health Care Industry myself after our company was bought out a few years back and we all lost our jobs.
But, I can tell you a few things, like for one, our company was bought out by another Insurance Carrier which, from what I heard, got rid of the health care part of our business (I mean the major medical coverage for the individuals and group employers we had) and only bought our company for its long term care business. Long Term care, meaning the policies that you buy to subsidize your nursing home care. Why are they interested in Long Term Care? I believe because there is guaranteed money attached to it, like Medicare/Medicaid. Is tthere guaranteed money from premiums coming in from employers and individuals? Not in this Economy.
Also, I can tell you on a personal level that many people cannot afford to pay the premiums for medical health care coverage anymore and are going without it. I personally, alone know of one man that, lost his job, which means he lost his healthcare coverage and then died out in the snow a few months back because he wasn't on prescriptions that he should have been on.
My sister just lost her job at a big company. She is nearly 50 years old and the premiums for women in that age group are very high. Will she be able to keep the coverage? Probably not. I have an Uncle in another state that has no health care coverage and needs to be on medications.
I have an individual policy myself. I just got the renewal premium notice.. although they did not raise the health care premium, they did seperate the rx coverage out of what use to be included with the health care premium and are now charging an additional $30/month for the rx coverage, so all, in all the premiums went up about $30 more a month.
I have another friend in her 50's that works for a school system. They keep her hours just under 40 a week so they do not have to provide health care coverage to her. Her husband had passed away and their child is on Medicaid.
Therefore, I think the Health Industry faces loosing a lot of money. The companies are closing so they are loosing groups. Just yesterday, a company that has been in business since the 1800's here closed. There goes another employer group covered by them, and it is happening, left and right.
But, let me give you another scenerio. I reviewed a bill froom a large medical provider just the other day. The charge for a tube to be put in an ear was over $718. This same medical procedure done in 2006 and in 2007 only cost $174.23! By the same Medical Provider.
Then another interesting scenerio, if we went to a small town doctor for the procedure the insurance company write off of the charge is much less than if we went to the medical provider I was just talking about. So... although you charge may be less with the small town doctor, the substantial savings in the write off from going to the larger medical provider helped in saving money. Therefore, my conclusion of this, is that the Insurance Company and the medical provider are so strongly contracted together and in cohoots they try to watch each other's backs because they are both very large entities.
So, where do you want to start... everyone, just needs to take a few steps backwards as far as money goes. The medical provider, the insurance company and the suppliers of medical equipment and drug companies. Everyone is just so greedy. I personally say it is the CEO's. It use to be there was an owner that cared. The CEO's get billions of dollars, yet, let their ships sink and crew be lost. What kind of captain is that! Take a reasonably salary, put the money you would have gotten back into the company by employing people and making our country stronger.
In the new housing industry. I know a contractor that has been asked by the builder to take a few hundred dollars off of his bill in order for the builder to offer more discounts to the home buyers. It was done. If not, the contractor may loose the business with that builder and who can afford to loose a job today.
I can tell you another case. Medicare pays apparently in direct deposits to the providers accounts. When an electronic deposit is there, paperwork cannot usually follow. If not checked and watched, Medicare people may not even know that a payment had been made to the medical provider because the medical provider's bookkeeper may not know about the payment that went into the doctors checking acct.
There is a lot of loose ends, every single place involved needs some quality control checks. In the news yesterday, it was announced that IInsurance Companies are going to work on not charging more in premium for those that have medical problems. Right! I have seen what they do. When you apply for coverage, you first have to get it. That is called Eligiblity. They can either approve you, deny you, rate you up or give you the coverage with riders which means the cmedical conditions they do not want to cover, will not be. So, the way they will get around not charging higher premiums for those with medical problems, will be by not taking or covering those people.
