Subject: Re: Re: Re: Re: Re: Re: Re: Re: Re: UNITED CHEAPSKATES

Comments:
: : : : : : : : : My spouse and I pay over $300.00 in monthly premium, only to have United Healthcare disallow $1,400 on a nationally-recommended, routine diagnostic colonoscopy! Now that I know they are in the business of micro-management insanity I will wait until I'm dying from colon cancer so the tab to United Healthcare will make the $1400 seem like chump change to the micromanagement chumps who make these penny-wise, pound-foolish denials of prudent, preventive health activities by those of us who are really paying the tab in ridiculously high premiums - the damn consumers! : : : : : : : : Was this test ordered by a physican as ROUTINE, or did he have a reason to have the test done?? : : : : : : : : In other words, was the test "medically necessary?" : : : : : : : The test was "medically necessary". I complained of symptoms. That's not the issue! The media makes a point of telling EVERYONE to have a ROUTINE colonoscopy! They better tell them to dig deep into their pockets to pay for it since insurance companies would rather have covered individuals to wait until they have to have major surgery costing MUCH, MUCH more than this important screening. : : : : : : That is the point!!! An insurance contract specifies what it will pay and what it will not pay. You can't just go to the doctor to have what ever test you want when ever you want them. What if a person wanted to have a physical every six months, should the ins. co. pay?? Do you have any idea what that would do to your premiums?? : : : : : : Most test should be medically necessary in order to be paid. In order to maintain an affortable premium, un-medically test can't be paid. : : : : : : Everyone wants to go to heaven but no one wants to die. If the tests are not medically necessary, pay for them yourself. That is just the way it is. : : : : : #1 - Heaven is not a place. It's a state of mind and one doesn't have to die to "go there." : : : : : #2 - Who should determine "medical necessity" - surely you don't believe the insurance company should. If a physician orders a test, isn't it UNDERSTOOD that the almighty physician has deemed it "medically necessary"? If the insurer questions that, then the insurer should also question having such a physician in its "family of physicians" - or is THAT decision based solely on the BOTTOM LINE. That's rhetorical. I know the answer. : : : : : #3 You obviously are a part of the insurance industry and therefore biased, lessening rationality of PREVENTIVE MAINTENANCE (MUCH CHEAPER THAN CRISIS MANAGEMENT AND REHABILITATIVE MAINTENANCE). : : : : Why did the MD order the test? Did he suscept anything or was it routine?? : : : : If the insurance is going to have to be the one to pay out the money, they get to be the one who determines whether it is necessary or not. : : : : You didn't address the issue if a person wanted to have a complete physical done every six months, should it be paid by the insurance co.? : : : : How would that impact your premium? : : : * Obviously, SHE did. : : : * It's this kind of illogical thinking that is why the costs of everything has been blown off the charts. The insurance industry makes plenty of money on those who pay but never or rarely use the insurance! If your "logic" is to hold, then the auto insurance industry ought to be monitoring my every move in my vehicle. Perhaps they ought to tell me when I can drive and where, what kind of vehicle to purchase, how many people I can have with me, and on and on. By mere definition, that's not what insurance is. It's meant to be a guard against catastrophy. If prudent diagnostic testing, in light of symptoms, isn't guarding against catastrophy I don't know what is. : : : *I can't imagine anyone would WANT a physical every 6 months. I don't think anyone ever WANTS a physical. If the doctor recommended it - perhaps. That's really splitting hairs though. We're talking about a potentially life threatening disease if not detected early not a routine tongue-depressing exam! : : : * Let's get real! The premiums are impacted by profit margin. What would happen to the insurance industry if everyone thought as you do and opted to decline all insurance. You'd be out of business and insurance industry top execs would have to downsize to just one mansion, one Bentley, one private jet, etc. Those of us who know the truth know that profit margins could be a result of miscalculations on investments, mismanagement of investments, etc. All in-house operations having no direct connection to individual health insurance consumers, except when they become the scapegoat and are expected to foot the bill for industry-wide corporate ills. : : She did not say how she felt about someone have a physical every six months. I don't most people would choose to do that. I was trying to make a point that some people go to the Dr. at the drop of a hat. Parents take their children to the Dr. when ever they have a runny nose. If the insurance co. has to control costs in order to control prem. There is a lot of abuse. Most family Dr. will order many check-up type tests if requested. : : I would say if this person had symptons that would make this test prudent, then I would not consider it "routine". : : I have been in the business many years. : : I pay,just for myself, $973.00 per month with a $2,500 ded. I have type 2 diabetes and can't change companies. : : I HATE all health insurance companies. : : However, the facts are , the insurance co., right or wrong, are going to be looking to determine with the test were medically necessarry. : : PS You say prem. are a function of profit. True, guess what, expenses impact profits. Sure, all claims couldn't be declined, but by the same token all and any claim can't be paid or the company would be just as broke. : ~~~~~~~~~~~~~~~ : (: However, the facts are , the insurance co., right or wrong, are going to be looking to determine with the test were medically necessarry.) ABSOLUTELY, but you won't see top executives dipping into their vast wealth vaults to pay for it, will you? You will see the middle class have to dip into their pockets, often times causing bankruptcy, loss of the very roof over their heads just to fund basic health care while top execs are on their yachts or a penthouse office laughing all the way to the bank, crying poor all the way. It's a farce but it's not the least bit funny. It is also the cause of economic downturn and it's just now becoming clearer who the real culprits are - and it's not the mothers worried about their kids. Most of the ills of this country can be attributed to CORPORATE GREED - pure and simple!

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