I’m insured – I should have rights.
Our Health Insurance is so screwed up with so many rules and regulations the regular person has little chance of comprehending what they can or cannot do. I do realize the list below is an over-simplification but one point should be clear; we pay for it, we should decide how it gets used.
Insurance companies should not be exempt from the anti-trust laws all other corporations must abide by. It’s ridiculous that they have been able to lobby their way out of the very protections we deserve. They should not be able to compare notes, discuss rates and plan designs with other Insurance companies. They should not be able to work out amongst themselves, who they will insure. (Blue will cover company A and Green get Union X). Ridiculous? Yes, it happens every day. Did you know that if a car dealer calls a fellow dealer and says, “Say, let’s agree to sell vehicle X only at MSRP.”, they have committed a felony for price fixing. Yet, our insurance companies do this all the time.
We should be able to decide which Doctor and Hospital to use. Just like your Auto or Homeowners Insurance, where we get to decide who is going to do the work, what they are going to do and the timeline based on the coverage we have. I’m sick and tired of my insurance company saying you can only go to this crappy hospital 10 miles away when a World Class hospital is 5 minutes away. It’s beyond stupid that anyone would have to ask permission of their primary care Doctor, which has next to no knowledge in a specific field, to go see a Doctor that knows that specialty inside and out.
Our chosen Doctor(s) should be the only one(s) to advise us on the proper treatment, drug and/or course of other remedies. Insurance companies can (by specific policy) limit the total cost, but should not have any say on individual treatments or specific procedures. This means we get to decide to limit we want spend on our health coverage. If I have a $100k limit on my policy, then that’s the maximum my insurance would be liable for. If I want a million dollar cap, I would have to pay more. If I end up needing more due to some unforeseen issue, oh well, I should have bought more coverage. Those who may need higher limits but cannot afford them, let the government subsidize them.
We should be able to decide which Insurance Company we want and what coverage we need. Some of us need a lot of insurance and some of us don’t need much. We all will need more as we age but it should be our choice. This will create a new market for insurance as well. Some companies will insure the youth and healthy with low limits and lower premiums and others will cover higher limits and higher premiums.
Doctors and Hospitals should not be able to allow an Insurance Company to pay a negotiated reduction for a patient’s visit, yet hold a cash paying patient responsible for the whole, retail amount. Doctors and Hospitals should also be barred from receiving advance payments (like they do with HMO’s) unless they are corporations like Kaiser.
Just like any other service you receive, you should be given a written estimate for the procedure. Adds or changes need your approval, unless you are unable to, but in any case, you should be aware of the risks. If you go in for a gallbladder removal and unless you suffer some sort of heart-attack or other significant complication during the procedure you should know that your bill will be X amount and your insurance will cover X percentage of it. No sticker shock. You should also be told before you ask for that box of Kleenex during your hospital stay, it’s going to cost you $85.00. Plus, you will get a clear, itemized invoice that clearly details the costs – not just a bunch of medical jargon and acronyms.
Each state will establish an Insurance Consumer Rights Commission. This is where consumers can go to file complaints, get answers and it would be governed by an elected Insurance Commissioner. The Commission would decide major issues like proposed rate increases, public paid for insurance programs for public employees and offer arbitration services settle disputes. The Commission members would be nominated by local city governments then appointed by a coalition of state elected representatives. Sever a single 5 year term.
All insurance rates and plans for public employees, all unions and large (+500 employees) must be posted in the public record. This speaks for itself.
Malpractice lawsuits claims must pass a review board made up civilian & medical personnel before going to court. If the case is found to have some validity, the cases can the move forward. However, the review board may also require arbitration first. All cases will have set monetary caps.