Michael Moore's Latest Target: Your HMO

[dmek25]

all i know is that my brother in law went years never going to the doctor, never using any of his insurance " benefits". now, he gets very sick, to the point he undergoes a heart transplant. my sister and their family and now thousands in the hole, money owed to doctors because of squabbling over what gets paid, and what they owe. i might not have my facts in order, but i can still see whats right and whats wrong

[Schneed10]

Originally Posted by dmek25

all i know is that my brother in law went years never going to the doctor, never using any of his insurance " benefits". now, he gets very sick, to the point he undergoes a heart transplant. my sister and their family and now thousands in the hole, money owed to doctors because of squabbling over what gets paid, and what they owe. i might not have my facts in order, but i can still see whats right and whats wrong

This is where things get personal, and I'm absolutely not going to take it there, only to say that a good portion of the problem stems from people not understanding the coverage provided by their healthcare plans. Many HMOs won't cover the most expensive procedures, and that's spelled out in their plan literature.

I certainly get that it feels "wrong." But the blame lies with the healthcare system in general, not with the HMO. The HMO is simply trying to operate within the flawed system. If the HMO paid the claim for the heart transplant procedure, they'd either have to charge a higher premium (one resembling a PPO's premium, which defeats the whole purpose of your bro having the HMO in the first place) or they'd go out of business.

It feels "wrong" because the fundamental belief at work here is that healthcare is a "right" as opposed to a "privelege." But the HMO isn't trying to deny someone their "right." They're simply trying to pay the bills. And no, their profit margins are not very high, just take a look at the trend in their stock prices.

[FRPLG]

Originally Posted by dmek25

all i know is that my brother in law went years never going to the doctor, never using any of his insurance " benefits". now, he gets very sick, to the point he undergoes a heart transplant. my sister and their family and now thousands in the hole, money owed to doctors because of squabbling over what gets paid, and what they owe. i might not have my facts in order, but i can still see whats right and whats wrong

I can sympathize with this situation. My family has faced similar circumsatnces. But I feel what you are saying is basically this, and please correct me if I am wrong:

That because your brother was insured for years and rarely if ever used medical services,he had 'banked' services, or he deserved to have coverage since he had not used the insurance. Hein lies the problem. Insurance is not a fungible product. You don't bank it and you can't trade it for something. In this case simply being insured IS THE SERVICE. Whether you use the benefits of the service is irrelevant. He got exactly what he was supposed to get through the years. A big well funded company sitting there willing and able to pay for his policy defined covered benefits. The company being there is the service. Apparently his policy did not cover a needed heart transplant, which sucks beyond belief. That is the problem. Not that the insurance did not pay for the heart transplant but that the heart transplant is so damned expensive that the insurance company simply CANNOT cover heart transplants and provide affordable insurance. See the problem isn't with the insurance companies. Sure they have issues just like any multinational billion dollar industry but their problems are small and rather insignificant to this discussion. The problem is that healthcare is so damned expensive. That is not insurance industry's fault.

Now I'd love to discuss why healthcare is so expensive. I suspect we'd jive pretyy well on that. Or at least we'd be in agreement on some things.