published Tuesday, September 1st, 2009

Insurance Industry

about Clay Bennett...

The son of a career army officer, Bennett led a nomadic life, attending ten different schools before graduating in 1980 from the University of North Alabama with degrees in Art and History. After brief stints as a staff artist at the Pittsburgh Post-Gazette and the Fayetteville (NC) Times, he went on to serve as the editorial cartoonist for the St. Petersburg Times (1981-1994) and The Christian Science Monitor (1997-2007), before joining the staff of the ...

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EaTn said...

While scanning this toon I was reminded of the carnival at the county fair when I was a kid. A favorite attraction was the "fun house" with mazes of funny and scary situations. One was a room of mirrors that made you look fat or skinny. I'm thinking the insurance companies have gotten so fat because all they have are those skinny mirrors with the reflection of a perfect body.

September 1, 2009 at 4:24 a.m.
moonpie said...

Acting the way some insurance companies do, you'd like think they would have a hard time sleeping at night or looking at themselves in the mirror. That's a generous view of them.

I think many of them are in such deep self preservation mode that they cannot admit mistakes and are unwilling to see any wrong-doing on their part.

Medical necessity is being replaced by profit margin.

If we don't enact change, we will continue to have the level of care we deserve.

I don't think that the average insured person is aware how much time and energy is spent by doctors, nurses, and their administrative staff fighting with insurance companies to get them to cover the services that are listed as patient benefits but are often denied. Our office can spend hours in the pre approval process trying to get the insurance companies to pay for services they reportedly cover. The companies throw miles of red tape in your face, in an apparrent hope that you will give up and pass the cost to the patient.

A government option would remove a profit incentive. It would decrease a doctor's administrative costs and allow staff to focus more on medicine than on money.

I think it's easy to oppose change when you either are healthy or have been protected from having to see how your insurance actually operates. It's like watching sausage being made.

September 1, 2009 at 5:22 a.m.
woody said...

Don't judge the book by the cover. For every 'fat cat' executive trying to get rich off the 'little people', there are surely many others attempting to do the right thing.

Insurance is a necessary evil. It is the last thing most people look to purchase and the very first thing to go when times get tough.

However, as one sales manager put it while training me as an agent many years ago, "You have to make them understand it's a choice of either paying a premium now or winding up a picture on a clear glass jug on a counter next to a cash register in some convenience store in the future."

This could become a 'rallying cry' for all citizens as the health care reform movement continues. Are they going to take charge of their own lives, or continue to allow a handful of greedy insurance executives, 'wishy-washy' politicians, and media pundits to rule over their desire and need for affordable health care?

Thank you for your time and attention, Woody

September 1, 2009 at 6:18 a.m.
rolando said...

There is another alternative -- become a victim of rationing, death panels [by whatever name], and ever increasing INVOLUNTARY insurance bills and rising taxes for ObamaCare health care. TANSTAAFL.

Your kids and your grandkids will pay forever for your health care today. Frankly, I would rather do it myself. ObamaCare will be in double-digit Trillions within ten years.

If ObamaCare is so wonderful, why does Congress run in fear of applying to themselves? Because they know it for the pig sty refuse it is.

I learned after forty years in .gov work that when it offers you a gold whatever, it is actually manure under the thinnest of plating.

September 1, 2009 at 7:09 a.m.
OllieH said...

This cartoon really snuck up on me, Clay. Very funny!

September 1, 2009 at 8:49 a.m.
aces25 said...

So the same government officials who want this government run option can look at the mirror with any less conviction? You are asking for a government that is not accountable to an authority to enter an industry that it is responsible for regulating! I can beat anyone in anything if I make the rules. And don't tell me they are accountable to the people they represent. There are too many examples to list proving otherwise.

The answer is reform and regulation to prevent abuse of power, not direct intervention. Too many people feel entitled to privileges that the government passes off as rights.

September 1, 2009 at 9:03 a.m.
nativecitizen said...

I have worked both in the private and publice sector and I believe the public sector is the worst. Everything done is under a microscope, because we are spending taxpayer's money. I was told that I would never get rich working in government, and I am not. The private sector has profit as a motivating factor, so lowering costs is always good. Insurance is our biggest benefit, and we pay for it. I do not like the thought of working my tail off so someone who is able can sit on his with his hand out, because he thinks it is his right. Bullsh*t. Government, stay out of this NOW. Better yet, we should insist that CONGRESS carry the insurance they are trying to force down our throats.

September 1, 2009 at 9:41 a.m.
Musicman375 said...

I work for a very large health care provider and I look at myself in the mirror just fine thanks. This is a horribly tasteless toon Clay. You really need to find new material.

I work my tail off to ensure every claim I come across is processed for the best benefit possible, based on the member's contract, and I can assure you I work with some really wonderful people (I don't process the claims, but I do research problem areas and find the proper solution to those problems when claims process incorrectly). All of you liberals are going to be sorry when you get your public health care plan and find out just how well (or how poorly in this case) the government takes care of you. Ask the people who work for the government about their benefits versus a person who has a private policy. You will find, as is true in all walks of life, that you get what you pay for.

Moonpie wrote: "I think many of them are in such deep self preservation mode that they cannot admit mistakes and are unwilling to see any wrong-doing on their part."

Well, let me tell you something that might be shocking to you Moonpie. As for me and all the people I work with, you are completely wrong. I personally expedite every case I see where the mistake at hand is our fault. That is a rediculous comment. And by the way, medical necessity is most often determined by 3rd party doctors. Also, notice I said doctors, not unqualified reviewers. To question a doctor's beliefs about medical necessity desicions is the same as someone coming to your work and accusing you of not truthfully fulfilling your duties, and/or not being qualified to fulfill such duties.

I saw a very true comment on one of these discussions some weeks back now, and forgive me for forgetting who stated it, but it is worth repeating (if only paraphrased): Health care is a privelage, not a right.

I suggest you all remember that, and leave the finger pointing to God and the sworn judges of the world. You don't know me and should keep your assumptions to yourself. It will make you look a lot less ignorant.

September 1, 2009 at 9:50 a.m.
molly_mann said...

I love the cartoon. I have also wondered how the health insurance companies look at themselves in the mirror. I don't see how the health insurance companies can be very proud of cherry picking, denying coverage, recission, and charging 4 times the price for guranteed issue policies. I guess they are proud of the money that they make.

September 1, 2009 at 10:04 a.m.
Sailorman said...

Musicman - give it up bud. These folks don't let facts confuse them. The gov is going to save them all - at no cost to them y'know. The big bad bogeymen, insurance companies, are solely at fault due only to their pursuit of the almighty dollar and a government program is going to fix that by god.

They'll drive you crazy if you let them.

September 1, 2009 at 10:20 a.m.
Snooksie said...

Musicman375.....You will learn on this website that the liberals always think they are right and the conservatives are wrong. They believe the government has their best interest at heart. Truth be known they are just like what they are accusing the big insurance companies of being. They are money and power hungry.

September 1, 2009 at 10:58 a.m.
EaTn said...

Snooksie- I don't trust the govt nor big business, but given that congress has to answer to the voters I'll take the govt over big business. Look what happened to the financial and insurance business the past few years when Bush decided they needed no oversight. Anyone thinks that big business has the public at heart probably hasn't worked for them. I have and know for a fact that the bottom line is what drives them. If they had loyalty to this country and people, they wouldn't be shutting down facilities and jobs and moving them overseas.

September 1, 2009 at 11:24 a.m.
nurseforjustice said...

I have worked for both a big insurance company and a huge hospital in our area. At the insurance company I reviewed cases for pre-authorization. At the hospital I send in the reviews. The hospital job is much harder but ONLY because of MEDICAID and MEDICARE, (notice those are the government programs), that we have to deal with. The private insurances pay the hospital better, faster and with more efficiency. We seldom get denials where private insurances are involved. If you remember a few years ago TnCare was in deep trouble because, in the words of our (D)Governor, "TnCare is like going to a grocery store and getting everything you want and not paying for it." That is the way it was for the receipients but we the real taxpayors were paying dearly for it. It is not much better now. It continues to rise in cost yearly because of lawyers like Gordon Bonnyman continually bringing suits against the state that make TnCare cover more and more. TORT reform is what is needed.

September 1, 2009 at 11:44 a.m.
Musicman375 said...

EaTn, just for my clarification, are you referring to insurance companies when you say "If they had loyalty to this country and people, they wouldn't be shutting down facilities and jobs and moving them overseas."? I know a lot of businesses are outsourcing to make money(including our gov't's social security office's customer service unit), but I haven't heard of any insurance companies moving over seas yet. Do you know which companies are sending our citizen's PHI (protected health information) across our borders? I will make sure that whichever direction I go in life, I never get coverage with them. Come to think of it, I would have to do some checking, but I'm not sure HIPAA laws would allow for that.

September 1, 2009 at 11:46 a.m.
Sailorman said...

Musicman

"I haven't heard of any insurance companies moving over seas yet"

You might check United Healthcare. I think they have outsourced at least a portion of their customer service operation. May be wrong but don't think so.

Nurseforjustice

Those that praise Medicare/Medicaid so loudly obviously aren't concerned with getting paid by them.

September 1, 2009 at 11:58 a.m.
Musicman375 said...

Thanks for the info Sailorman. And thanks for the laugh earlier too. I needed that.

September 1, 2009 at 12:19 p.m.
nurseforjustice said...

Sailorman said: "Those that praise Medicare/Medicaid so loudly obviously aren't concerned with getting paid by them."

Well they will be concerned when doctors and hospitals have to go out of business because of the lack of reimbursment. I know this is an extreme statment but that could very well be the end result if Obamacare is passed.

September 1, 2009 at 12:35 p.m.
Sailorman said...

I don't know that it's all that extreme a statemnt - it's already happening.

September 1, 2009 at 12:43 p.m.
whoknows said...

I apologize before hand for the length of my post. I had to separate this into two posts… I, too, work for a large insurance company. I, like Musicman375, do not process claims, but work on the afterwards of them. If something denied, I'm constantly talking to the member or the provider seeing what can be done. And typically, if a service denied, it was denied by an OUTSIDE party consisting of Doctors who review the cases and determine the medical necessity. I believe Musicman375 mentioned the same thing. I also talk with other insurance companies all around the nation, including but not limited to, all the MAJOR insurance companies that everyone has heard of, as well as hundreds that you will probably never in your life hear mentioned. Not once have I ever talked with an American insurance company who out sources their call centers, including United. Is it easy to actually get a hold of a human to talk to at all of these insurance companies? No. At times you have to go through 5-10 minutes of computer prompts before you speak to a human… but every time I call any of them, I get an American who tends to be very helpful (until you get a person every once in a while who just hates their job and takes it out on who ever is calling). So, why does health insurance cost so much? 1. Progress. As medical science progresses, doctors accumulate more costs. If you go to the dentist, and have a periodontal disease, there are new techniques of laser surgery to help with certain procedures. These new machines costs quite a bit of money. To offset the cost of 10s of thousands of dollars the doctor just spent, they charge more for the surgery. When more and more doctors are charging more for a surgery, the insurance company then reviews their allowed amounts and decides that since the cost is more, they should be paying more. In turn, it will eventually (but not immediately) cost the customer a little more out of pocket to keep the insurance. 2. Government run health programs. Programs like TennCare cost the populace nothing, yet promise to pay for practically everything (after many attempts to get them to pay as mentioned by nurseforjustice). Yet they do not pay the full amount charged by the hospital, physician, dentist or clinic. Therefore; the aforementioned practitioners are forced to take a loss or to write off the amount not covered by TennCare since TennCare will not make the patient pay for it. Major hospitals in the area budget a loss of millions to tens of millions to TennCare annually.

September 1, 2009 at 1:57 p.m.
whoknows said...
  1. People refuse to accept cheaper treatment. Prime example being generics. My wife, who works in a local pharmacy, can tell you story after story of people who come in with a prescription for (example:) valium but will refuse to take the alternative generic diazepam, which will not only cost them less, but will cost the insurance company less as well.
  2. Americans. Who is the most unhealthy nation? Health is generally correspondent with ones weight. I know there are MANY exceptions as well as MANY other determining factors, but typically, the most unhealthy persons are those who are obese. America has the world’s most obese population. Not to mention nearly 20% of the population (generic studies) smoke (other countries have higher smoking rates, but many of these are third world countries that have little to no organized health care system at all). Those who are constantly going to the doctor because of their unhealthy lifestyle, yet refuse to change, also drive up healthcare costs. Now, my last reason listed is a little more speculative than factual (as the previous three), but true nonetheless. So that brings us to this, how do other countries keep health costs down? Many countries supply government funding (which, yes, is taken through small taxes to the general populace) in order to help medical providers with the costs of new technology, equipment and drugs. I would consider it a fair trade to have a 1% yearly tax added to my deductions (which would ultimately be upwards of $100,000,000 a year nationwide) to help doctors with costs in order to provide the general populace a smaller costs for healthcare.
    So, to comment on the cartoon, OF COURSE health insurance companies are trying to make money. That’s what they do. If they didn’t make money, then they wouldn’t be in business. But at the same time, they are subject to the trickle effect like every other business in the world. Costs go up in one area, they go up in other areas. Does the healthcare system need reform? Yes it does. But it does NOT need government control. That is not what our government (as a democracy) is for. They are here to help out, not take over (such as a Socialistic or Communistic society).
September 1, 2009 at 1:58 p.m.
Musicman375 said...

Whoknows, I couldn't have said that any better myself. Thank you for the time you put into that post. Hopefully that will bring new light to the situation for some of the readers.

September 1, 2009 at 2:06 p.m.
nurseforjustice said...

very well said Whoknows.

An interesting fact is that 20% of people in practically any group, use up 80% of the Healthcare. Of course this is an average. This statistic is from the major insurance company i used to be employed by. My point in saying this is simple. If there are really 47 million without insurance, it is reasonable to assume that most of those are low income families/individuals. Since these are generally what comprise the 20% mentioned above, then Obamacare will be over run with claims spouting into the billions, yeah even trillions before you know it even if medical cost decreases some. (of course it can't decrease too much because of things mentioned by Whoknows). There are just too many things that drive the cost of medical care for the government to control. I don't see it happening fairly. We the taxpayors will suffer no matter what your status.

September 1, 2009 at 2:14 p.m.
Sailorman said...

Well done whoknows

September 1, 2009 at 2:17 p.m.
moonpie said...

Musicman,

I sympathize with you that you yourself do not wish to be painted with a broad brush. To the extent that I have implied that everyone who works for an insurance company is unethical, I apologize. I know that's not the case.

Never the less, I deal with insurance companies every day. They bungle claims on a daily basis. They deny services that are covered. They make excuse after excuse as to why they have delayed and denied before finally giving in.

I have never heard one once admit a mistake. Not once. Even when the mistake was obvious.

I have no doubt that good people work for these companies. Some of my best friends work for insurance companies. They are good people. Still, on a daily basis, how many insurance companies behave is highly suspect.

Healthcare reform is a product of health care delivery in the United States. How health care is delivered is controlled prinicpally by insurance companies. The largest controlling group in health care delivery is the insurance industry. Insurance companies want no change that will take any power or money away from them. They have resisted the concept of co-ops until the threat of a public option surfaced.

And yes, right now, in the United States, health care is a "privelage," as you say.

That's exactly what some of us are trying to change.

So I will concede that good people can work within an industry which denies coverage to people with benefits, drops people from insurance rolls because they forgot to report "acne".

Of course these things don't happen with every claim, but they happen with alarming frequency.

So, if people in your industry would like to prove to the rest of us that your companies behave in an ethical manner, then prove it in actions, not in words.

Stop these abuses and then I'll believe you. Until then, I'm going with what I witness on a nearly daily basis.

For me, actions do speak louder than words.

September 1, 2009 at 3:29 p.m.
moonpie said...

P.S. We do not have the same fights with Medicaid.

September 1, 2009 at 3:32 p.m.
Musicman375 said...

Moonpie,

Well, I cannot speak for everyone in the health care industry of course. What I can tell you is that in my area within the company, we ABSOLUTELY, POSITIVELY, BEYOND A SHADOW OF A DOUBT, TRUTHFULLY, (can I make this any clearer?) DON'T FIND REASONS TO DENY CLAIMS. I have listened to that acusation for years and have yet to see it, as I said, in my area of work. The most common reasons for claims denying and needing to be adjusted later are due to clerical errors on the claim form or are errors mistakenly caused by a claims processor. Sometimes claims are processed under the wrong patient's name or under the wrong provider's name. Some claims deny due to frequency limitations or contract limitations of some sort such as age limits. There are many reasons why claims deny, but again, I reinforce the fact that we don't look for reasons to deny claims.

The contract limitations are negotiated between the excecutives and group administrators and the members are made aware of those contract limitations upon signing up for the coverage (whether they understand the limitations changes from member to member). Many people are upset for the wrong reasons when claims deny and point fingers until we explain to them what the contract states.

Again, I cannot speak for all insurance companies, but to me I see these allegations that claims are denied for bogus reasons as a conspiracy by people who have convinced themselves that something is happening that isn't.

You stated that you know the people who work for these companies are good people, and I completely agree with that. Well, who do you blame then? Don't say the insurance companies, because a company isn't a living entity with a soul. It is an organization run by these "good" people.

Also, "And yes, right now, in the United States, health care is a "privelage," as you say. That's exactly what some of us are trying to change." is disturbing to me. I believe whole heartedly in our democracy and free enterprise. If healthcare becomes a right, that means we are living in a socialist or communist country. That's just plain scary.

September 1, 2009 at 3:56 p.m.
jackattack said...

The example of the rest of the world makes not a dent in the head of all these loonies. Even the loonies who defend the moral integrity of the health insurance "industry" (if a business that produces nothing can be called such a thing). France has the best health care system in the world, and the conservatives are terrified of it. After all, if someone says that its the best system in the world, they must be wrong. Because America is the best at everything. Everything. Right? Read a little. Do some research.

Maybe musicman and co. are just afraid that they'll lose their precious bloodsucking jobs?

September 1, 2009 at 4:24 p.m.
Sailorman said...

See what I meant musicman?

September 1, 2009 at 4:33 p.m.
Musicman375 said...

Yeah I do. It is unfortunate for sure. :(

September 1, 2009 at 4:55 p.m.
Sailorman said...

We've heard from one person (musicman) on the insurance provider side and one (moonpie) on the insurance claim submission side. Moonpie and I have had this discussion before but, at the risk of being repetitive, I'll reiterate a few points from a different perspective - a practice manager in a large specialty practice. The clientele is about 60% medicare/medicaid patients.

Insurance companies - yes we have problems with them and, as musicman points out, they are by far mostly paperwork issues. HIPAA was originally supposed to make uniform the filing requirements but that didn't happen - at all. Each company still has their own peculiarities. When you're dealing with a number of companies, that's a problem. BUT by talking with the companies reps, the vast majority of these are settled fairly. Expensive process but it works.

Ahhh you'll say, a single payer will resolve that problem.

With Medicare/medicaid there's a different set of problems. I won't get into the details of their constant ractheting down of payments and the cascading effect that has. As long as the paperwork is right, they pay - promptly. It's the game they play later. Under the guise of "rooting out fraud" they employ what are tactics not seen since the KGB went out of business. If you want details, look back at some of my earlier posts or just search for "Medicare audits". They will try to recoup costs, on the flimsiest of excuses, going back as far as 2 or 3 years. No practice can cough up that kind of cash. No problem, they'll set you up on a payment plan! You can appeal, at your own expense but even if you win, you're out significant cash. I can tell you that, as we speak, there is a battle going on involving $4MM (yes, million) that is completely bogus and so far legal costs are over 500K. And you wonder why doctors charge so much? Could you run a business under such conditions?

The latest scam involves the legibility of doctor's signatures and initials.

Do NOT assume I'm against reform. Have a great day y'all

September 1, 2009 at 5:02 p.m.
Oz said...

What happened to the negotiations on C-Span with pharmaceutical companies? Wasn't that part of the change?

http://www.redstate.com/bs/2009/08/20/its-pretty-bad-when-you-have-air-america-calling-you-a-liar-mr-president/

September 1, 2009 at 5:15 p.m.
moonpie said...

Musicman and all,

I always enjoy reading the posts here. It is good that each person can bring a piece of the puzzle to the table.

It is very difficult to be all inclusive in this discussion. Just because I argue one aspect does not mean I am blind to other facets of an argument. I've said it before that there are many things that our current system does exceptionally well.

I judge a system, though, by not what it does best, but by what it does worst.

Our current system facilitates the economic destruction of American families with relatively few protections compared to other industrialized nations. The majority of bankruptcies in the United States being triggered at least in part by medical expenses and the only way for most people to qualify for government assistance is to lose the vast majority of their resouces and become a virtual unproductive member of society.

We have police, fire, coast guard, mail services which are government run to deliver services that smaller, private, market-based models do not service well. Health care is no different.

You would still have choice. You don't have to use the postal service now. If you have the means, you can bypass the socialized mail system and use Federal Express.

Not having healthcare as a right is chilling to me. To me, it's the same as saying we should have private fire departments. Only if you had a policy with a participating station would your house be covered. To me, it's simply a matter of ethics.

Yes, I will may make less money. Yes, I may pay more in taxes. Some of that will be offset by lower insurance premiums.

However, I think it's the right thing to do.

I don't really think that those who are opposed to a universal plan think it is appropriate to let their neighbor's house burn. However, it's strange that they can't see that these two issues are ethically equivalent.

September 1, 2009 at 6:19 p.m.
maj said...

Musicman375 said: "Hopefully that will bring new light to the situation for some of the readers." (in response to the comment by whoknows)...

Unfortunately, too many of these readers will never see the light, or even acknowledge the light.

Whoknows: Great post! Thank you for making an intelligent statement in a calm and respectful manner!

September 1, 2009 at 6:32 p.m.
InspectorBucket said...

Hey, Musicman:

This one is not for you or about you.

Maybe you do keep your conscience alive by helping a few folks navigate the byzantine and heartless ways of the insurance industry.

Make sure that you walk the line and keep it that way.

This one is for the Hollow Men.

Who are they? They are the ones who press a suit against the grandkids' insurance coverage to recover hospital and surgery costs after grandma, visiting from out of town, falls down in the front yard, breaks her leg, and makes an insurance claim to cover her surgery.

Talk about foxes in the hen-house.

Come back, Woody Guthrie.

Well, you say that I'm an outlaw, You say that I'm a thief. Here's a Christmas dinner For the families on relief.

Yes, as through this world I've wandered I've seen lots of funny men; Some will rob you with a six-gun, And some with a fountain pen.

And as through your life you travel, Yes, as through your life you roam, You won't never see an outlaw Drive a family from their home.

September 1, 2009 at 7:29 p.m.
una61 said...

It bothers me that the liberal left continues to demonize the private health care industry and, by association, their hard working, tax paying employees. Maybe they think that if they can destroy the credibility of the private health care insurers they can elevate the credibility of their government option (whatever that is). I remember a government option for newspapers. I think it was called "Pravda".

September 1, 2009 at 9:30 p.m.
rolando said...

No, una61, it is called "The New York Times".

September 2, 2009 at 5:53 a.m.
jackattack said...

3/4 of the people who file for bankruptcy due to medical debts have had health insurance. 75%. Most medical debtors are well educated. See:

"Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attrib- utable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001."

Read it yourself. http://download.journals.elsevierhealth.com/pdfs/journals/0002-9343/PIIS0002934309004045.pdf

Not that some here will be swayed by FACTS.

September 2, 2009 at 1:27 p.m.
workingmom2 said...

I too work for a major health insurance company. I feel very secure in my line of work because I do not belive that smart Americans will let the government run our healthcare system the way they are so wanting to. If we as Americans give into this healthcare reform we are on our way to being a communist country and I don't know about all of you but I am not ready to live like that.

Also, do I think health insurance is a right? Absolutely!!!

Should I have to risk possible unemployment to insure all Americans? Absolutely not!!!!

Should I have to pay extra taxes to pay for insurance for people who are uninsured for whatever reason? NO!!!!!!!!

In my opinion this is one thing the government does not need to control of. People have always and will always take advantage of things that are free.

September 3, 2009 at 11:04 a.m.
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