Insurance companies serve a very important function in our society. The purpose of insurance is to share risk. Risk is the amount of economic loss that someone is willing to assume in an activity. For instance, a bank would not loan money for the purpose of buying a house, unless the house was protected against losses such as fire, wind and other perils. That protection is provided by a Homeowner’s policy.
A loan to purchase an automobile would not be available unless the car was insured for losses by theft or collision. That protection is provided by an auto policy.
Health insurance is a policy that shares the risk of losses caused by injuries or illness. A share of the risk is assumed by the individual through a deductible or co-pay. In-other-words, if someone visits the doctor, that individual may be required to pay the first $15 or $20 of the visit. The health insurance company assumes the risk of the remainder of the cost.
That shared risk comes about through an exchange of ‘consideration’. Consideration is value. The insured pays a premium in exchange for the promise of the insurance company to pay certain costs associated with the insured’s health care. Which brings us to the controversy surrounding the government’s efforts to institute what some call universal health care.
No matter what side of the argument you are on, in favor or against universal health care, one issue has been settled. President Obama stated publicly that it is impossible to insure the ‘uninsured’ without additional costs. So, the idea that this will be a ‘deficit neutral’ policy has been debunked by the administration itself. Either taxes go up to pay for the program, or health care will have to be rationed to keep costs neutral, or bring them down.
In response to the public out-cry about a government health care program, the administration has called the insurance companies villains. After all, insurance companies exclude preexisting conditions for some period of time when an individual enrolls (however that is not always the case with group policies), and insurance companies are making a ‘profit’.
PreExsiting Conditions
Think about the concept of risk and preexisting conditions. An individual has a home that has been damaged by fire. Would a homeowner’s insurance company now write a policy that would cover the repairs to home caused by the preexisting fire? Of course not! That is not shared risk, that is bad business.
An individual has a preexisting health condition, say diabetes. Purchasing a policy that would exclude the treatment for diabetes for a limited period of time (usually two years), now results in a shared risk. The health insurance company will cover the person for other perils, and if that individual pays the premiums over time, that exclusion regarding the preexisting condition is then dropped.
Is it possible for the government to insure everyone in the United States and force insurance companies to provide policies without regard to preexisting conditions? It is possible, but not without driving the cost of health-care way up. After all, the money to pay the doctors and hospitals have to come from somewhere and President Obama stated that ‘We are out of money’. Since the government doesn’t earn money, its only source of revenue is taxes.
Profit
Insurance companies are being cast as the bad guy since companies make a profit. Which do you prefer, companies that are well run that make a profit, or a company like General Motors that required billions of dollars of taxpayer money to bail the company out? A profit is what allows companies to expand services and provide jobs. Companies that fail to make a profit, go out-of-business.
The government not only fails to make a profit, as a well run business entity should, it runs at a deficit. The latest example is Cash for Clunkers. Not only was taxpayer money used to subsidize auto sales, now car dealers are complaining that the government is not sending the checks for the Clunkers that were promised. It appears that many buyers will have lost their old cars and now face repossession of the new cars purchased since the money for the program did not actually exist.
This does not bode well for a government run health care system.
Tort Reform
Doctors and hospitals must practice defensive medicine. People will sue for anything. Tort lawyers use a ‘shot-gun’ approach when filing a malpractice lawsuit. All doctors, nurses, technicians and hospitals involved in a case are named as a defendant, whether that party had any actual responsibility for the claimed injury and damage.
We need a loser pay system, which provides that anyone who brings a lawsuit and loses, is required to pay the other side’s attorney fees and expenses. That would do away with most frivolous lawsuits and bring the costs of health care down.
Big Government Solution
Government should be required to live within its means. It does not, and the government, not insurance companies, is the villain in this scenario.
The founding fathers did not foresee a large, powerful centralized government. That is what was the war of independence against England was all about. The US Constitution delegated specific powers to the Federal Government, and it does not specify taking over any private sector industry.
Medicare and Medicaid are government health care programs on the verge of collapse. Even President Obama admits Medicare cannot be sustained. No program can be sustained when it runs at a deficit and all government programs run at a deficit.
Universal Health Care will run at a deficit from day one and that is just bad business.
ABOUT THE AUTHOR
Dr. Michael Birzon is an attorney and adjunct professor with Florida Insurance University/University of Central Florida. Dr. Birzon has litigated claims for over 30 years and is the author of the Accredited Claims Adjuster Designation approved by the State of Florida. You may contact Dr. Birzon at (407) 927-1235 or email at: flainsu@mail.ucf.edu
http://www.ce.ucf.edu/insurance
Filed under Health Insurance by on Sep 6th, 2010. Comment. 
OPINIONS: Traffic and parking Tickets: Are the financial or legal?
I am working on organizing all my documents into a folder structure that will easily let me find anything at later time.
These are some of the folders:
Education\Diplomas
Education\Research
—————
Financial\Bank & CC Statements\Capital 1
Financial\Bank & CC Statements\Chase
Financial\Credit Reports
Financial\Disputes
Financial\Insurance
Financial\Loans
Financial\Pay Stubs\2009
Financial\Pay Stubs\2010
Financial\Receipts & Invoices
Financial\Taxes
—————
Food\Menus
Food\Recipes
—————
Legal\Accident Info\Motorcycle Accident 07.09\Pictures
Legal\Accident Info\Motorcycle Accident 07.09\Police Report
Legal\Tickets
—————
Medical\Health Insurance
Medical\Records\Hospital\Motorcycle Accident 09
—————
Sentimental\Cards
Sentimental\Letters
So, what do YOU think? What category should parking and traffic tickets go under. Is it a legal document? or financial? If only I can somehow use tags like Gmail…
Legal\tickets – if you are going to pay it
Financial\disputes – if you are going to contest it.
Why file it when you can just pile it?
Filed under Health Insurance by on Sep 6th, 2010. Comment.
Assurant Health Insurance Company of Arizona is one of the premier medical insurance companies in the state of Arizona. Of course, Assurant of Arizona is not the only choice in the Arizona health insurance market so read on to learn a little more about the different Assurant AZ health insurance plans available and if they make sense for your health insurance needs.
A company that has been growing within the United States, Assurant is given a rating of A- by A.M. Best meaning that they are doing everything they are financially stable and able to pay claims. The company was founded in 1969 and is based in New York; however the health care division of this great company didn’t get founded until 1982; so it’s a relatively new company within the “top dogs” of health insurance. Although it is relatively new to the United States, Assurant has established themselves as a global company that operated in the countries of Canada, United Kingdom, Denmark, Germany, Spain, Italy, Argentina, Brazil and Puerto Rico.
Although Assurant is not as big as some other ones in the state of Arizona, they do offer some great plans that can be of benefit to many people. They offer health care coverage to people that aren’t covered through their employers or other groups and they cover about 1 million people within the United States. It is important however, to shop around before deciding on which Arizona health insurance company to sign up with. Based on their ratings by A.M. Best, Assurant’s underwriting companies (Time Insurance Company and John Alden Life) are one of the top sellers in temporary health insurance and the company was one of the first ones to introduce Health Savings Accounts (HSA’s) into the market.
Within the state of Arizona the company offers 4 plans that are all fairly comprehensive in nature. Below you will find the 4 plans listed with a brief description of each one. The description will not include every piece of information possible about the plan, but it will summarize the most important things about it and the cost for each coverage option.
1. Coremed: One of the best things about this AZ health plan is that it offers you the option of locking in your rate for up to 36 months if you were to enroll and that you will be protected anywhere in the world. You will use the PPO network meaning that you won’t need the need of referrals when it comes to getting a second opinion or going to another doctor. You can also receive what they call a “Healthy Discount” if you maintain good health, which will give you 10% off services.
The beauty of this plan is that you can choose from a variety of deductibles according to your health care need. They offer deductibles from $0 to $10,000 with the highest deductibles having a lower monthly premium because they pay higher out of pocket expenses. Copays for doctor visits in case you have a deductible are $35, while you have to pay $45 if you don’t have a deductible. For prescription medications you will only pay $15, however if you want more than a generic medication you will have to pay $25 plus 50% co-insurance after a $500 deductible (the family deductible is $1,000). Hospitalization cost varies with deductible (it can be $0, $200 or $750) and you will pay a $75 fee for going to the emergency room.
2. Maxplan: When you apply for this plan you can expect a response within 48 hours and you can also lock in your rate up to 36 months depending on the coverage. You will also be covered everywhere in the world, be offered the “Healthy Discount” if you maintain good health and be using the Preferred Provider Organization (PPO) network. The deductibles on this plan range from $0 to $25000 making some of the rates lower than the Coremed plans.
Co-insurance for the services range from 0 to 50% and the out-of-pocket maximum can be $7500 or $10,000 depending on the plan you choose to purchase. Just like the other plan, you only pay $15 for generic medicines and refills, while brand name and specialty medicines have a deductible of $500 for individual and $1,000 for families.
Apart from the deductible you will have to pay a $25 copay plus 20% co-insurance. There is no limit on office visits and if you have a deductible you should expect to pay $25 while no deductible plans should expect to pay $35. The emergency room fee is also $75 and hospitalization is covered after you meet the deductible.
3. OneDeductible: This type of plans is Health Savings Account compatible and is very famous within the state for that same reason. It is chosen by many members because the plan can protect you from large medical bills, provides tax advantages ad keep premiums affordable. This type of plan has an individual deductible plan ranging from $0 to $5,000 and a family deductible from $2,000 to $10,000 accordingly. The prescription coverage, office visits and preventive services are covered with an emergency room fee of $75. Hospitalization is also covered.
4. SaveRight: This is the other side that Assurant offers to Health Savings Account members. The customer will only have three choices of deductibles: $2,200, $3,000 and $5,100 for an individual with the family deductible being two times that. Office visits and prescription medications are covered, however with prescription medications you will have a $2000 out-of-pocket maximum for brand and generic combined. Hospitalizations are also covered and emergency room visits are the same as the other plan ($75).
Although Assurant is not as big within the United States yet as compared to the more familiar names like United Healthcare, Blue Cross Blue Shield of Arizona, and Humana it has accomplished many things in the little time is has been in the Arizona health insurance market. The numerous plans and choices that they offer are very beneficial for people looking to save money on insurance. The best way to decide which Arizona health insurance company is right for you is to compare quotes from multiple companies. Get started finding Arizona health insurance today!
Filed under Health Insurance by on Sep 6th, 2010. Comment.