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As a former health insurance exec, I’m worried for folks this week. If history is any guide, a lot of you visited the ER between Christmas and New Year's - which means soon you just might get a big “surprise” bill from your insurer, and it won’t be pretty. Let me explain (1/11)
There’s a good chance the hospital you went to was "in network," but the doctor who treated you was NOT. In other words, you think you’re in the clear after meeting your deductible. But then a bill for $2000 arrives in the mail - to pay the DOCTOR. (2/11)
This happens a lot. It’s because of a scheme quietly hatched by insurance companies like the ones I worked at, where they decide which hospitals and doctors to include in their networks. They make these choices based largely on what will maximize profits and minimize care. (3/11)
There are 2 ways to control health care costs: 1) Attack the unit price of health care goods & services (eg, Rx drugs, physician care); or 2) limit the *use* of those goods & services. As I know first-hand, the insurance industry has an awful record controlling unit prices (4/11)
Insurers don’t have enough leverage at the negotiating table to control unit prices. So they aim to make it harder to use the goods & services. How? Make you pay high deductibles. Make your dr get permission from them before treating you. And: Limit your choice of doctors! (5/11)
When I ran PR at Cigna, we abruptly dropped a popular hospital from our network. The result: Thousands had to change doctors to avoid getting big surprise bills. I was working in the Connecticut office and my team had to manage the spin around this: (6/11) https://www.courant.com/news/connecticut/hc-xpm-1994-05-12-9405120248-story.html
It was a nightmare for many people. But it was just another day on the job for us. Making big changes to provider networks happens often in the insurance industry. Execs even have a term for it: “blowing up” the networks. And it’s even worse now. (7/11)
Insurers now routinely exclude groups of doctors, including ER docs and anesthesiologists, from their networks... even though they treat patients at in-network hospitals. This is what happens when you let profit-obsessed insurance companies run your health care system (8/11)
So if a politician tells you that you need private insurance companies to be “gate-keepers” to your medical care, they either don’t know how the system really works -- or they’re taking tons of money from them in campaign donations, to parrot their talking points. (9/11)
And if that politician says they’re against surprise bills, but their health “reform” plan protects the status quo & empowers private health insurers, that’s a tell. It means their rhetoric is just that: rhetoric. (10/11)
As I know firsthand, insurers are driven by 1 thing: profit. That makes them the worst possible gatekeeper for your health. I hope you don’t get one of these awful bills I just described. But if you do, as a former insurance insider, the last thing I'll be is “surprised.” (11/11)
