A Psychologist’s Suggestions For Improving Your Health Insurance

Health insurance company earnings were released, showing billion dollar profits by the major insurance companies. Despite these earnings, all of the insurance companies continue to increase their premiums on an annual basis. I am writing as a small business owner, health care provider, and health care consumer to describe my concerns about health insurance abuses.

As a small business owner, the annual 15% to 45% health insurance premium rate increases are unaffordable. Each year, as our employees age, we reduce benefits to afford minimal health coverage. As health consumers, our care is inferior and restricted by insurance company bureaucracy, and we have additional increased out of pocket costs. Just this past week, it was reported on how health insurers have posted billion dollar profits, at the cost of reduced care for the insured. How is this fair? It is time to remove the anti-trust exemption that protect insurance companies, and permits them to abuse the public.

As a health care provider, my income has systematically been reduced, as insurance companies increasingly dictate the care I provide, the fees I receive etc. Additionally, we have been forced to spend more time and money on hiring administrative staff to deal with insurance company errors, obfuscation, and refusal to pay for things that they must. Thus, health insurance companies increase health care costs tremendously simply through their administrative harassment of health care providers. As an example, I counted more than 200 claim errors from one insurance company in one year. This meant that over 200 hours were spent rectifying insurance company errors! Resolution of the problem only occurred after I sought assistance through Congressman Pascrell’s office (for which I am immensely grateful). It is no surprise that private insurance administrative costs of 35 to 40% are way higher than those of Medicare, which are 3 to 5%. This high rate of administrative costs is unacceptable, and insurance accountability must be implemented.

In my quest to resolve the high rate of insurance company errors, I learned that insurance companies routinely employ personnel to deal with bad publicity. They employ entire departments to deal with legislators and the public. They spend unknown amounts of money on advertising and lobbying. In this time of economic distress, and with so many problems funding proper health care, what are insurance companies doing spending so much money on advertising and public relations? Who is looking into the huge burden they add to rising health care costs through all of their administrative errors, public relations gambits, advertising, etc?

In the early 1990s, I joined several health insurance panels as a participating provider. Initially, the insurers offered reasonable fees, I signed up, hoping to be part of the solution to the country’s health care woes. Within two years, our fees were slashed dramatically. I maintained provider participation with a few panels whose rates were acceptable. Although I dropped out of the lower paying plans (whose compensation would have left me with an income that is similar to the starting salary of a teacher), it was amazing how my name remained in their list of participating providers (a phenomenon known as the “phantom panel”). In all of these years, the fee has never been raised in the few panels in which I remained. In contrast, my medical health insurance rates have risen dramatically, as have my rents, taxes, utilities, malpractice insurance, etc.

There is something wrong in a society when the healers, who require great educational training, are paid at far lower rates than those that deny health care, as is the case with the insurance company executives. Their compensation packages are in the millions of dollars each year, while the health care providers struggle to maintain a middle class standard of living. Health insurance companies contribute to the spiraling, out of control health care crisis.

In my opinion, any successful health care reform must include:

1. Limits on the compensation of insurance executives (in the same way that incomes of all medical health providers have been reduced).

2. Financial limits on insurance company expenditures on lobbying, advertising and public relations efforts. Those funds need to be re-directed towards actual health care.

3. Insurance companies exemption from anti-trust regulations must be eliminated.

4. Insurance company accountability and reduction of their claims processing errors and administrative costs must be reduced so that they fall in line with that of Medicare (3 to 5%). Stringent penalties need to be assessed upon insurance companies that fail to follow this ruling.

Dr. Tamara Sofair-Fisch is a psychologist with practices in West Orange, New Jersey and Lawrenceville, New Jersey. She, and her husband (also a psychologist), specialize in relationship problems, parenting issues, spiritual growth, anxiety, depression, life transitions, stress management and provide individual, family, marital/couples and group psychotherapy for these and many other issues. For more information, please visit their psychology practice in Central, NJ [http://www.emotionalsolutions.net] website.

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