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Insurance companies, sell policies to customers with
purpose of protecting you and your property against damage or harm with
only their promise to assist you when accidents occur. This
promise to pay or
trust is something that cannot be
measured or a value placed upon it. Only when you have a claim of
damages will you fully understand whether or not that
promise of trust is upheld. Many
times you are told to read the fine print to make sure that the coverage
you were told or led to believe was there, unless the promise is in a
written contract-only then is this promise valid.
But like the old snake-oil salesmen from the past,
salesmen learn to manipulate information in order to sell insurance
policies. If the salesman cannot sell that policy-he will not make
any money. Do these salesmen deceive clients with their promises?
Do salesmen always tell the truth about their product or service?
Bottom line is that unless they sell their product or service-they will
not make any money.
Regulations and laws are supposed to protect insurance consumers against
fraud; but only if those laws are enforced. Enforcement is the key but
without these regulations, fraud or greed will be present.
"The Insurance companies use fraudulent claims as proof that strict
regulations need to be in place to protect the consumer however the
real evidence shows a different result. "There's a widespread
national myth that people are "faking it". I understand that Connecticut
spent over a million dollars to unroot all those fakers in their system, and
only found 6. Real cost efficient."
Guilty until proven
innocent
The regulations used by the
insurance carriers is not to prevent fraud but rather to deny
claimants access to their healthcare coverage. This
strategic plan is used throughout the entire insurance industry to
deny claims. The hurricane Katrina proved this idea
when homeowners were told that their insurance policy did not cover
them against specific losses when they were told when they bought
these policies that they would have coverage.
Profit vs.
Insurance Protection-Whenever profit is involved in any aspect of
insurance coverage-the question will arise "who is benefiting by the
decision?" Is the decision to help you and the insurance
coverage you were told or led to believe by a salesman or it is the
decision made in the best interest of the
company.
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"Every year, law firms such as Parker Scheer, go to war against some
of the largest insurance companies in America, with the goal of
leveling the playing field between the rights of the individual
consumer and institutions which, by their size and resources, dwarf
even the world's leading banks. Every year, the insurance cartel
pours more and more money into the coffers of State and Federal
legislators, pressing for new laws that will further insulate them
from paying their customers what they deserve. The trial lawyers
have taken quite a black eye in recent years, largely because it's
sexier to write a newspaper story about a woman who breaks her toe
and wins a million bucks, then it will ever be to write about a
family who lost a father to a drunk driver and has been waiting more
than four years to receive their insurance proceeds. The games
insurance companies play to evade the responsibility they owe to
those they insure and those injured or killed by those they insure,
demand a legion of committed trial lawyers who can stand up for
their clients the way nine Attorneys General stood up against
Zurich."
Another
Insurance Company Caught Defrauding America. So What Else is
New? |
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"In the spring of 1987, as a physician,
I caused the death of a man," testified Dr. Linda Peeno, to Congress.
"Although this was known to many people," she continued, "I have not
been taken before any court of law or called to account for this in any
professional or public forum. In fact, just the opposite occurred: I was
'rewarded' for this. It bought me an improved reputation in my job, and
contributed to my advancement afterwards. Not only did I demonstrate I
could indeed do what was expected of me, I exemplified the 'good'
company doctor: I saved a half million dollars."1
"The decision about the California patient [in need of a heart
transplant] was made from the 23rd floor of a marble building in
Louisville, Kentucky," added Peeno, herself a Louisville resident, a
medical reviewer for Humana and medical director at Blue Cross/Blue
Shield Health Plans. Peeno had no license to practice medicine in
California, but to her employer, this was irrelevant. "The patient was a
piece of computer paper, less than half full. The 'clinical goal' was to
figure out a way to avoid payment. The 'diagnosis' was to 'DENY.' Once I
stamped 'DENY' across his authorization form, his life's end was as
certain as if I had pulled the plug on a ventilator."2
Peeno summed up her work in a chilling
message: "Whether it was non-profit or for-profit, whether it was a
health plan or hospital, I had a common task: using my medical
expertise for the financial benefit of the organization, often at great
harm and potentially death to some patients."3
Welcome to "utilization review" (or U.R. as it is called) a system
whereby the bureaucratic review of HMOs second-guesses the calls of
practicing physicians while the health of seriously-ill patients
dwindles against an ever-expiring clock."
The End of Health Care: Who Plays God in
a System Bent on Profit?
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"It now seems
that the property/casualty insurance industry’s profitability
for 2005 will be extraordinarily high even with hurricane
losses. In an article from the January 2, 2006, National
Underwriter entitled, “Despite Disaster Losses, Industry
Profits Higher Through Nine Months,” the paper reported on a
study from the Insurance Services Office and the Property
Casualty Insurers Association of America that said, “Through
nine months, net income rose 4.4 percent to $28.8 billion, and
the year-to-date combined ratio—at 100—was the second best
nine-month ratio on record.… In a commentary published in
conjunction with the figures, Robert Hartwig, senior vice
president and chief economist for the Insurance Information
Institute in New York, noted that the $20.4 billion surplus
increase—attributable mainly to the $28.8 billion of net income
and to new capital of $6.3 billion—‘was not expected’ in the
wake of this year’s hurricanes. … Commenting on the combined
ratio result, Mr. Hartwig characterized it as ‘uncanny,’ adding
that the ‘surprisingly low’ level stands as ‘stunning proof of
the resilience of the industry.’”
These results
come on the heels of sky-high profits for the industry.
According to the Insurance Services Office, after-tax profits
for the property/casualty insurance industry for 2004 were $38.7
billion. ISO estimates Katrina losses will total $34.4 billion
and Rita losses at $4 to $7 billion. The high estimate for the
two storms is $41.4 billion or $26.9 billion after being lowered
by the corporate tax rate of 35 percent. And of course, the
federal government is covering flood-related Katrina losses
through FEMA’s National Flood Insurance Program (NFIP). The
Consumer Federation of America has estimated that 2005 was the
third greatest profit year in the property/casualty industry’s
history, despite the hurricanes of 2005."
THE INSURANCE
INDUSTRY’S TROUBLING RESPONSE TO HURRICANE KATRINA
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"Judith Packevicz would have had her cancer treated sooner if not for
this process. The New York woman suffered from a rare form of metastatic
cancer of the liver and, through 1998, was delayed and denied
potentially life-saving treatment by her HMO. According to the family's
lawsuit, her HMO — Mohawk Valley Medical Plan (MVP) — refused to pay for
a liver transplant recommended by her oncologist with the support of all
her treating physicians, causing the woman to live out a death sentence.
Without the transplant, she faced certain death. Her quality of life,
according to the lawsuit filed May 27, 1998 in Federal Court, Northern
District of New York, was "indescribably miserable both physically and
mentally." Her son, Thomas Dwyer was "ready, willing and able" to donate
part of his liver to save his mother's life. Fourteen friends of the
family also volunteered to donate a part of their livers. According to
the family, the treatment was available close at hand at Mt. Sinai
Hospital in New York City, but at a six figure cost. But on the grounds
that it "does not meet the medical community standard of care for this
diagnosis," the HMO's medical director said no, without a physical
examination. On this life and death decision, there was no explanation
of why the procedure failed to meet the standard."
The End of Health Care: Who
Plays God in a System Bent on Profit?
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"It's one thing to have a doctor in a corporate office in another state
vetoing the decisions of a patient's doctor. But some of these
bureaucrats are little more than clerks with no medical license. The
interference of such clerks in the doctor/patient relationship is
tantamount to the practice of medicine without a license, and
legislation sponsored by state medical boards to confront the problem is
proliferating across the nation.
At some plans, these so-called "utilization reviewers" are clerks and/or
nurses empowered to override treating doctors' decisions in emergency
cases. In turn, many doctors have dubbed these over-the-phone
authorizers as "1-800 nurses from hell."
The End of Health Care: Who
Plays God in a System Bent on Profit? |
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Insurance strategy within the
United States
"Types of Risk
The major sources of risk in disease management contracts include:
• Prevalence: The risk that the population will include a
greater-than-expected number of patients with the disease or
condition.
• Patient Severity: The risk that the patients from the population
will present at a more-advanced stage of the disease than expected.
• Complication: The risk that a greater-than-expected proportion of
the patients from the population will present with complicating
conditions.
• Cost: The risk that the unit cost of services will be greater than
expected.
• Protocol: The risk that the accepted protocols for treating the
disease will change over time toward more intensive or expensive
treatments.
• Duration: The risk that the treatment will last longer than
expected. Disease management companies may be victims of their own
success. If they can improve survival in the patients they treat,
those patients will be treated longer, on average, than patients not
treated by the disease management company."
Disease management
Individual purchasers are put into one of scores or hundreds of
groups when they first sign on. Then, as rates increase for
some groups (because they happen to have the high risk policies), the people
without claims are encouraged to buy a new, cheaper, policy. Pretty
soon you're in a death spiral, where the only people left in the
original groups are the ones with the highest risks and
voila, they can increase for "the whole group" without affecting 99%
of their customers. Needless to say, they don't weep when the
people left in the group decide they can't afford it any more and
drop the policy, or lose it for non-payment.
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Most of the industrialized countries
offer a national health insurance to their citizens as a duty to its
citizens. However, the USA does not offer any type of national coverage
for its citizens except for those people on or below the poverty level
and those people who have retired from the work force. The issue of cost
of health care is basically that a country (its citizens) can either pay
up-front (National health care) or at the back-end.
This issue of the paying up-front or
paying at the back-end is best explained in this fashion. Healthcare is
expensive-the costs are spread throughout the entire society. Because
when a person is ill, whatever economic resources (s)he has become
focused in on his/her medical needs. This cost can be spread out over
the entire population or it can rest upon this individual, which in the
long run is still shared by the total populace. With National Health
Insurance, everyone pays upfront for potential health needs. With the
USA system, the individual must bear the cost and society pays at the
backend when these people declare bankruptcy, loose productivity because
they are unable to work, interest rates and the cost of goods and
services go up in price. Pay now or pay later-BUT WE ALL PAY.
"Let society deny the
existence of this problem-because the government does not want to cause
a panic; let business zealots preach that by accepting
my doctrine-that
you will be protected against health crisis's ; let businesses only
accept the short-term goal of profits-when the long-term outcome of
these illnesses
will be the downfall of these same institutions. The death of one
individual may be a tragedy for his/her immediate family, the deaths of
millions will have serious consequences for society.
A close friend of
mine became infected in the work environment, denied any type of
compensation or concern by society (her behavior was the cause of her
disease and she/(us) must bear the consequences of her action-she chose
to become infected-she worked in a high-risk occupation). She
lost employment opportunities, friends, and health benefits because of
this disease. All of this without any recourse because of her
choice to work as a healthcare worker. We can live in a world of denial-that it will only happen
to someone else; when in fact, as the rate of infections increases, the
likelihood will be that you too will join this
select group of outcasts. The choice of society
is either to pay-now or pay-later. Therefore, let us educate our
citizens with factual information-it is far cheaper to educate than it
is to treat. The choice is yours." James A Wright,
2001
Diseases have changed society
throughout history, The Black Death during the Middle Ages where
at least 25% of the total population of Europe died with The Plague.
European society was shaken to its core, governments collapsed; Jews
were thought to be the carriers of the disease since they did not
succumb to the illness like others. (Jews believed in daily hygiene.)
And they were discriminated against and feared by others because they
were considered so different from the normal culture.
This is by no means a medical site.
Any information pertaining to HIV/AIDS and Hepatitis regarding
treatment, medications, alternative medicines etc, are for informational
purposes only. For health care questions we ask that you please contact
your physician.
We are also not a political site even
though there are many issues regarding social changes, legislation which
are deeply intertwined with political leanings and the influence of
special interest groups. There are no good or bad sides of an issue,
just the strong desire to show all points of view and how they affect us
all.
The magnitude of a society’s social safety nets will be the
critical point on the effects of catastrophic event : less of these nets
- the greater the impact on society, more of those resources -
less the influence these events will have within that culture.
"When you have written to The President, Congress, Your Senator and
nothing comes of it,
YOU TAKE IT TO THE STREETS."
"Conditions in society which
are not defined as a problem and for which alternatives are never
proposed, never become policy issues. Government does nothing and
conditions remain the same."
T.R.Dye, Policy Analyst
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material available in our efforts to advance understanding of
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scientific, and social justice issues, etc. We believe this constitutes
a 'fair use' of any such copyrighted material as provided for in section
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information for research and educational purposes..
For more information go to:
http://www.law.cornell.edu/uscode/17/107.shtml.
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This website is dedicated to
my wife, whose belief in this organization and the understanding
that through education, understanding about infectious diseases,
changes people's perception towards those who are positive.
And that this change assists those infected in a positive way.
For this support I am truly grateful and thankful that I married her
and love her still, for all these years. JEH |
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