US Medical Insurance: How Much Choice?

[Loren Pechtel]

Today in the mail I received a flier from my insurer enticing me to sign up for and participate in a wellness event. If I sign up and participate I will receive 25 dollars in a gift certificate. I don't know why they do these things except that in some way it must be profitable.

Are they required to do these thing by some regulation? Are they really trying to make people healthier, which has been disproven using this method? Do they just want data that they can sell? Are they looking for sick people that they can make money from? Is it a marketing ploy to get more business?

I ask because it seems everything would cost less for everybody if they just insured and treated people and didn't try to "entertain" them. Before retiring I received these type correspondences a couple times a week. Should they be spending money hiring staff at minimum wages to tell me it's allergy season and how to stay healthy around pets? This isn't insurance.

But maybe I'm just an old-fashioned stick in the mud.

It's about getting you to do healthy things.

I'm a little annoyed with my insurance over this--they have sent me multiple things about getting $20 for gym check-ins. Hey, how about my "gym"--how about the same credit for check-ins at trailheads. (Admittedly, a bit problematic as the majority of trailheads don't have cell service, the app would have to remember and send the data later.)

Sounds more like they have a business/profit agreement with the gym but need the numbers to collect.

No, they're trying to encourage exercise. They don't care what gym.

 

[Loren Pechtel]

In recent years, many insurance companies give money or other rewards for those who workout on a regular basis. Medicare Advantage Plans and Medicare supplements do the same thing. It's called "Silver Sneakers". Yeah. I hate that label too. There is a huge amount of recent evidence that regular exercise leads to better health outcomes. So, sure, you can say it's the insurance companies attempt to lower their costs but why would anyone not like being able to join a gym or exercise group if their insurance company paid for it. Nobody is being forced to workout, but all of us should have get regular exercise if we want to decrease our risks of certain diseases.

Yup--Silver Sneakers gives free access to several gyms in town.

 

[Toni]

Huh? The insurance companies don't say the networks are externally imposed. Networks are doctors that agree to the price list and the like the insurance demands and don't have too many patient complaints. Unfortunately, they also tend to look at how much treatment the doctor provides without considering the patients--they have a legitimate interest in weeding out the ones that overtreat but there have been cases of doctors with two offices and having one accepted, one rejected--the one being rejected was in a lower class area with less healthy patients.

In my experience the doctors that prescribe the most are preferred. Do you have any examples of doctors running into problems by over-prescribing tests, meds, etc.?

I spent 15 years at highly rated world class health care provider. Laboratories frequently suggested cheaper tests that would provide the same information or pointed out that X test was really a duplicate of Y test (the duplication was because Medicare and Medicaid insisted on paying differently or not paying for some tests, depending on whether the test was to screen for a disease or to diagnose a symptomatic patient---exact same test, exact same methodology, equipment, supplies, reporting, etc. Just different price schedules which necessitated different test mnemonics/billing codes = unnecessary expense that did not add any value to medical test or treatment)--something that was not necessarily immediately apparent to physicians who might not frequently order certain tests. All of us from labratorians to custodians to nurses, doctors, aides, etc. worked hard to ensure efficient and accurate diagnosis and treatment because it was the best for the patient. It was also the least expensive way to do medicine.