What Is Up With Health Insurance?


Over the years, I have tried to stay in my lane or area of expertise.  I have written about startups, small businesses, risk and intellectual property plus the occasional article on legal technology. Using my understanding of basic business principles across industries, I am now looking at health care as mentioned when I recently wrote here on Front Health, a startup that helps companies with the value of their healthcare by shifting focus from volume to outcomes.

Last posted by Mary Juetten | Forbes

The impetus for this article is born out of personal frustration over almost fifteen years of living in the U.S. and struggling with the healthcare system for most of that time. I moved to the U.S. in 2005 from Canada and for several years had no issues, mainly because we were fortunate to be a relatively healthy family.

However, when a family member had multiple concussions, I started to see the serious cracks in our health coverage and the incredible level of waste in terms of bureaucracy, not to mention the errors. I spent hours reviewing explanations of benefits and writing letters to both the Mayo Clinic and our insurance provider. There were so many errors and much confusion about coverage; all of this centered on the money side, with nothing to do with the care. At one point, I was listed as the patient for a medical procedure that was never performed on me!

More recently, I was in a car accident and needed physical therapy. I went diligently, under the care of a doctor, and in the end, less than half of my sessions were covered. But that’s not the real issue. I had treatment in Arizona and all of the physical therapy claims are now reviewed for medical necessity by a company contracted by the insurance companies. So, the administration of my claim drowned me in paperwork. I had roughly 30 sessions and this company sent a letter out for each session telling me to send in more information. Not once, not twice, but a total of four times over the four months. The number of letters grew each time as I took more sessions. Despite the response by my provider, the letters continued. The last round had each of the appointment in a separate envelope with two pieces of paper, one that just had my address. And in the end, those last set of twenty-six letters were unnecessary because my benefits capped my visits,  with nothing to do with medical necessity. It’s a system on autopilot and it’s out of control.

Also, the insurance system does not focus on prevention. I have an excellent primary care physician who now works under the MD VIP personalized medicine model and we spend hours each year on my test results, focusing on preventing heart disease and stroke. I have had elevated cholesterol and taken medication that is covered by insurance. However, a blood test that goes beyond the traditional cholesterol numbers and is better at detecting risks for heart and stroke health issues is not covered by insurance.  And for that matter, neither is the annual fee that to MD VIP. And don’t get me started on the lack of insurance coverage for meditation, yoga, and licensed massage therapy; all which contributed to my improved test results and ability to embrace and manage stress. In other words, I am covered if I have a heart attack or stroke which would be much more expensive than my preventative costs, which are routinely rejected by my insurance company.

I believe that the cost of my health care premiums is not the issue; the insurance companies simply refuse to look forward. That said, the healthcare premiums have been outpacing inflation for years. Research by Of Two Minds here shows that workers’ deductibles grew 176% and coinsurance by 67% from 2006 to 2016, while wages only increased by 29%.

Enter Haven, the recently named joint health-care venture between Amazon, J.P. Morgan, and Berkshire Hathaway hired one of my idols as CEO, Dr. Atul Gawande, who wrote the Checklist Manifesto, amongst other numerous books and achievements. With the three CEOs of the major players plus Dr. Gawande, I have hope that they can address the problem of rising health-care costs and the lack of preventative care coverage. When the name was announced in early March, Boston-based Haven also launched a website at havenhealthcare.com with a stated vision to “create better outcomes, greater satisfaction, and lower costs for their U.S. employees and families.” The same article outlined the exciting news that, after working on the disruptive change and improvement necessary for the three founding companies’ 1.2 million employees, that Haven will sell products and services to other companies. I will be in that line, or likely online. #onwards.


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