Hey Everyone!! :-)
I've got a little more of Alyce's adventure to share with you, today! Enjoy! :-)
Excerpt from sci-fi satire novel:
"So, they pay money to a company each month and that company guarantees to pay if anything happens that applies to the type of insurance they provide?"
I nodded. "Yes, though, like I said, in theory. Insurance companies only make money if they don't have to pay out too much, so they try not to pay if they can get away with it."
"How do they do that?"
"It depends on the type of insurance. Most types of insurance have limits on the payout, so the insurance company won't pay anything above that limit. Aside from that, they'll try to find excuses for why they shouldn't have to pay."
"What kind of excuses?"
"Again, it depends on what kind of insurance we're talking about. For medical insurance, which is supposed to pay for medical treatment if the insured person gets sick or hurt, there are a few different ways insurance companies try to get away with not paying. For example, if a doctor prescribes a certain medication for a person, their insurance company might refuse to pay because they have decided that medication won't be covered. So, the patient then has to either get their doctor to prescribe something else that is covered or pay for the medication themselves."
"What if the medication that isn't covered is the only medication that will meet the patient's needs?"
I shrugged. "They might be able to get the insurance company to pay for it if they argue the case and get their doctor to back them up, but they might not. And even if they do, they usually end up having to pay a higher price for that medication than they would for a medication that was covered."
"Wait a moment, I'm confused. If they successfully make their case that the medication should be covered, why does the patient have to pay anything for it? Doesn't that mean the insurance company will pay."
"Ah, well, that's one of their other tricks. Most medical insurance policies have what are called 'deductibles' and 'copays'. The insurance doesn't pay for anything until the patient has paid out enough money to cover their deductible, which is usually thousands of dollars, for the year. And even after the insurance company starts to pay, they only pay for a percentage of the costs. The rest of the costs have to be paid for by the patient. That's what's called a 'copay'."
"And patients have to deal with all of this while they are sick or injured, possibly fighting for their lives?"
"I'm afraid so, sugar."
"I have to agree with Paxtiguantialablingondintalblinganham, your system for healthcare is barbaric."
I shrugged. "I won't argue with you. It used to be worse. It used to be that medical insurance companies were allowed to refuse to pay if they claimed an illness or injury had existed before the patient bought their insurance. Guess how often that claim was made?"
"From what you've described, I'd wager that it was more often than not."
I nodded. "And they also used to be allowed to set limits on how much they would pay for a patient for a year and also for their whole life. But a law was passed that made it illegal for them to do that, so they don't anymore. But there are still plenty of other tricks they use to get out of paying."
"It occurs to me, that depending on the circumstances, if one of your insurance companies can play such games long enough and prevent the patient from receiving care, the issue of their having to pay may become moot if the patient dies, in the meantime," observed Squid-boy.
"Yep. That's certainly a possibility. And having a specialized staff who are trained in how to argue with insurance companies and convince them they have no choice but to pay is why doctors and hospitals have to pay for billing staff."
"And the expenses that your healthcare providers are forced to bear are the reason why patient's lives are allowed to depend on the caprices of private industry?"
I shook my head. "No. The reason that happens is because my country has allowed our healthcare system to be controlled by for-profit corporations. Since their profits are dependent on not paying for healthcare, there's a built-in perverted incentive structure that can't be overcome. And as long as those corporations are allowed to continue to control our healthcare system, people will continue to die from lack of care. The expenses that providers have to cover are the reason why they sometimes are more concerned with a patient's ability to pay than they are with the patient's health status. But the reason some patients aren't able to pay is because our government has failed to prioritize ensuring that all our citizens healthcare needs are taken care of."
"And there's nothing that can be done about that?"
I shrugged. "There's plenty that could be done. Every other modern country on our planet has some form of guaranteed healthcare coverage through their government, which they pay for with taxes. But, so far, the politicians in my country have lacked the political will to do anything like that. Mostly, because they've been bribed by the same corporations that are currently running the healthcare system."
"Which ties back into the rampant corruption in your political system that we discussed before," said Yax.