Imagine what would happen if health insurance companies ran the educational system…
When it came time to send your child to elementary school, the insurance company would make you pay for something out of pocket first; in this case, Kindergarten. Just pay that deductible, and let them handle the rest!
Whoa, not so fast… They’ll only cover what’s considered “usual, customary, reasonable, and necessary.” According to your policy, they will pay for 75% of elementary school… which is only 1st-6th Grade. That means you’re responsible for 7th and 8th.
When it comes time for high school, they’re even less generous. See, the insurance company doesn’t like having to pay for more than it absolutely has to… and they actually employ persnickety statisticians to analyze and compute numerical data that determines what is “reasonable and necessary.” In this case, they’ll cover basic courses like Algebra, History, and Remedial English, but if you want Calculus, English Lit, Physics, or PE, that’s gonna cost ya.
Suppose you’d like to apply to a few colleges… You’ll need to take the ACT and SAT for that, but the prep course and actual tests will again be your responsibility. And speaking of college, that level of education could be considered “unusual, uncustomary, unreasonable and unnecessary,” so you definitely wouldn’t be getting any assistance there.
While this analogy may seem silly, I have to wonder how many people would skip 7th & 8th Grade because they had to pay for it out-of-pocket? How many would leave out the “non-covered” subjects in high school?
Fortunately, our educational system doesn’t operate this way… but sadly, health insurance companies do! The health care system is nothing more than a business. Their clients (you and me) are liabilities, not assets.
Now, it’s a no-brainer that some form of insurance coverage is necessary. One night in the emergency room followed by a day or two in the ICU can bankrupt a family. But some people are under the perception that the insurance company will happily cover any and all expenses, without question. As my brilliant colleague, Dr. Michael Dorausch once said, “Insurance is not a credit card for magically free health care.”
Show me an auto insurance company that pays for car washes, oil changes, windshield wipers, fuel, and servicing, and I’ll show you a health insurance company that will actually pay for all of the care you need. Neither company exists!
These companies have a financial obligation to their shareholders to make profit. The easiest way to boost revenue is by covering less and denying more of the services you want and need.
Here’s the bottom line… Health insurance companies do not have our best interests at heart. Do not depend on them, or expect much cooperation on their part. Putting your health and well-being in their hands is like relying on OJ to find the “real” killer. Never gonna happen!