• Adrian Lim

Insurance Does Not Offer Assurance

Updated: Jun 6, 2020


April 30, 2019 ⋅ 6:00 P.M ⋅ Adrian Lim

As mortal beings, we humans all have to worry about our health, and care for issues which may be detrimental to our well-being. These can vary from curing a simple everyday sickness, such as a common cold, to treating a more serious illness, such as cancer. No matter the severity, treatments always tend to be extremely pricey and costly. Due to the rapidly advancing world, many new methods and medical procedures have been created and discovered which can now cure numerous different illnesses. However, due to the ridiculous costs of these treatments, many individuals cannot afford to pay for them. Thus, the concept of health insurance coverage was created in order to resolve these issues.



Health insurance was created to help people fund health treatments or pay for medical procedures. However, the system itself is extremely convoluted and there are different terms to understand before receiving coverage. For health insurance companies to cover an individual, he/she has to pay a premium, which is a set monthly amount, in order to maintain active coverage.[1] This premium fee is just the tip of the iceberg hiding an avalanche of other costs. In addition to this recurring fee, an individual also has to pay a deductible, which is another set amount towards the medical bill, before the insurance company begins fronting the cost. For example, if a plan has a deductible of $1,000, then assuming a procedure costs $3,000, the individual has to pay $1,000 of the $3,000 before the insurance provider steps in to help pay. In addition to those fees, there are also coinsurance and copayment costs. A copayment is a price that an individual has to pay when he/she goes to either visit the doctor or ask for a prescription refill. The coinsurance, on the other hand, is the percentage of the billing fee that the insurance company pays after the individual has paid the deductible. Most of the time, the insurance company does not cover 100% of this cost, so often individuals have to shell out extra money even after paying the deductible. Looking at all these fees, the purpose of the insurance company becomes extremely blurred.[2]




Although they were created to help individuals receive healthcare, insurance payments make the process feel extremely complicated and expensive. As such, even those who are covered by health insurance cannot receive proper treatments for more advanced procedures. Most of the time, insurance companies that cover a greater percentage of the bill charge larger premiums. In essence, better healthcare services come to those who pay more. But for individuals who cannot afford these premiums, many receive lower coverage plans. So when they do encounter a major medical procedure, many families can barely pay the deductible fee. Even when they can, they are left with a ridiculous coinsurance cost because the insurance does not pay a significant percentage of the bill. If a more premium insurance company does cover a greater percentage of the bill, families are still left with a ridiculous amount. Assuming the company covers 80% of the bill after the deductible, individuals would be on their own to pay off the rest of the 20%. However, for a minor surgical procedure, the final cost could be upwards of $15,000.

Twenty percent of a large sum such as that would still come out to be $3,000, and although that is definitely a more manageable cost compared to $15,000, it is still a hefty amount which people may be unable to afford. Even though medical treatment overall is expensive, jacked up pricing in the United States has made these treatments even more unaffordable. Although the level and quality of care is similar to other developed countries around the world, prices in the US have been shown to be significantly larger, simply due to billing differences. Therefore, residents in the US have an even tougher time affording quality medical treatment.[3]


As a result, many people cannot afford to receive certain treatments because of the expense. Insurance companies were meant to alleviate these issues, but often times, they cannot help families, especially from the lower or even middle class. Also, many individuals may be sick but do not know exactly why or how to treat themselves. The logical thing to do would be to see the doctor. But because there is a copayment to actually see a doctor, those who are sick may be less inclined to visit the physician. Many of these individuals living paycheck-to-paycheck invest long hours into multiple jobs, yet can barely afford basic necessities, such as healthcare.


Patients are not the only susceptible victims to these capitalist tricks. Rather, doctors are also harmed by this system. Insurance companies often find ways to cheat physicians in order to maximize their profits. For doctors to get paid by healthcare companies, they have to go through a ridiculous and confusing process. The complexity of this procedure often poses many different nuances and subtleties. If not executed properly, insurance companies can pocket the money from physicians for themselves. To avoid this situation, many doctors spend even more of their personal money on hiring individuals to both help them navigate these complex processes and to ensure they are receiving the fair and right amount.[4] Other times, insurance companies may outright refuse to pay physicians by denying their claim for payment. In addition, for doctors who work for larger companies and hospitals, these middlemen drive up costs for both the patient and the working physician. As such, instead of actually benefiting the patient, these doctors end up working for a larger institution trying to maximize profit.[5]


In today’s society, healthcare is not considered a necessity but rather a privilege. Health should be the number one factor in a person’s life; however, based on the capitalist nature of our society, this is unfortunately not the case. Healthcare has become so expensive that it could be considered a luxury only for those who can afford it. Reform is necessary and changes must be made.


References:

  1. https://www.medmutual.com/For-Individuals-and-Families/Health-Insurance-Education/Health-Insurance-Basics/What-is-Individual-Health-Insurance.aspx

  2. https://health.usnews.com/health-care/for-better/articles/2017-07-13/5-ways-insurance-companies-meddle-in-your-health-care

  3. https://www.cnbc.com/2018/03/22/the-real-reason-medical-care-costs-so-much-more-in-the-us.html

  4. https://www.forbes.com/sites/peterubel/2018/11/30/the-insurance-companies-that-are-most-likely-to-refuse-to-pay-doctors/#284b42b77f77

  5. https://thehill.com/opinion/healthcare/375348-health-cares-fundamental-problem-your-doctor-doesnt-work-for-you

About the Writer


Adrian Lim is the Visual Arts Director for Speak Out for Surgery at University of California - Los Angeles.

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