I Think Insurance Companies Are Fighting Us

[Vikingbeast]

Fighting us people with HA that is.

Read in our paper yesterday that the insurance company covering our county employees (of which I was one for 10 years back in the day) will NOT cover certain emergency room visits.

To be fair, OK, some of the stuff on that list made some sense, like ringworm and some other stuff.

But some of it was like WTF???? Chest pain from a cough? Really?

OK, OK, I get it, some utilize ER for nonsensical reasons. Especially those of us with HA (at least I know I have).

I no longer have the article and am working from memory off an article I scanned quickly, but I kept thinking to myself that since HA is a blooming new disorder, I bet a lot of needless ER visits ARE responsible for this.

Yet on the other hand, if one is suffering from long term diarrhea, one could dehydrate. Chest pains from a cough? How can you NOT visit the ER over that?

[MyNameIsTerry]

If you were suffering from long term diarrhea you would see your GP. If they thought you were in danger from dehydration they would get you to a hospital, not necessarily A&E.

If you had chest pain from a cough then it surely depends on how much? Pains from coughs are common and are an issue for a GP.

Insurance companies certainly do screw people but I would expect their medical policies to be based on what medical professionals say and not a bunch of suits in a meeting. It would only take one mistake to see them sued big time.

[damo123ie]

I work for an insurance company and while I agree there can be specific cases where a person is hard done by or not treated well by insurance companies at the same time this idea that insurers are out there trying to screw each policyholder is just a news-paper rag headline.

85% of an insurers outgo is based on claims. Insurers pay huge sums of money in claims each year and like it or not if the insurer doesn't at least get this amount back in premium then it will go bust and insolvent. Fraudlent claims are rampant in the health insurance sectors and like it or not they do ramp up premiums. This is money not going back to the insurer but instead being paid out to insidious policyholders submitting false claims.

There is a case for high unfair margins in insurance premiums but in general this is a management decision. If you look at the case of Ireland a lot of foreign insurers came in an undercut the irish insurers in our motor industry lately. The problem is these premium were not sustainable and thousands lost out when such insurers went insolvent and pulled out of the market. So much for cheap insurance premium.

The insurance market is highly regulated and government, legal and medical practioners have a say in how claims are submitted and premium set. The idea that the insurance market is buoyant at the moment is a fallacy. Insurers are facing tough times and if you look at the dividends being paid to shareholders as profits these are very small.

It's all too easy to take the blame out on health insurers but 95% of the case this is misdirected. The issue lies elsewhere.

[Vikingbeast]

I'm talking about the corrupt US system.