Routine Office Visits
Narrow the range of covered medical services to eliminate the use of insurance on routine office visits, while expanding the use of health savings accounts (HSAs).
Insurance was originally established to guard against the risk of financial devastation resulting from accidents & debilitating diseases. Routine office visits are a common event, a certainty. To fund office visits through insurance premiums is a more expensive way to pay for them. HSAs allow the individual to use tax exempt dollars to pay for medical services even if those services are not recognized as covered health insurance expenses. In fact, by excluding this level of service from being eligible for insurance reimbursement we eliminate a layer of administrative service and expense both for the insurance carrier and the physician’s office. A reduction in administration would have an immediate and dramatic impact on the cost of health care, as 25% of every dollar that currently flows through an insurance company goes to administrative costs.
To use insurance to pay to see a doctor for a sore throat, sports physical, or annual routine exam does not shield the patient from the cost, but only the knowledge of the cost! It is absolutely necessary for individuals to have an awareness of the cost of medical services.
By implementing these two actions, Americans should see a reduction in the cost of health care of 35% to 45%.
About: Insurability, Accessibility, Portability and Pre-existing Conditions.
A National Insurance Mandate would impose smart regulations concerning issues related to insurability, accessibility and pre-existing conditions clauses. These issues are addressed below:
- Eliminate the difference between commercial & individual coverage.
- Commercial Coverage (“GI GR”): In most states health care through your employer is guaranteed issue, at guaranteed rate (“GI GR”). However many businesses do not offer health care and many people try to secure an individual policy. If a single health care company were to immediately open the door and provide “GI GR” to individuals, that company would be flooded with new business. The newly insured’s often consist of:
- Persons who were denied coverage due to existing health conditions
- Persons who could not afford rated policies
The solution is a national mandate that specifies all providers of individual policies in all States must provide a guaranteed issue at guaranteed rate (“GI GR”), to all applicants (as is the practice in NY). “GI GR” would not have a tremendous effect on the current cost of health care.
The uninsured are currently getting free health care and the cost of this health care is passed on to employers and employees who purchased fully insured plans. Employers with less than 50 employees are the purchasers of fully insured health care programs.
Pre-existing condition clauses:
A pre-existing clause states that the insurance company will not pay for a health care concern that existed before you became insured.
Waiving Pre-ex clauses:
Commercial Carriers offer a “takeover” provision, which simply states that if coverage is being replaced (a business is changing providers and replacing Aetna with Blue Cross) then the new carrier will recognize the exchange and accepts all risks, meaning that no individual will be subject to repeating a pre-ex clause; the key being “continuity of Coverage.”
The exclusion would be for the individual who walks around without health care coverage and then one day discovers that he has a serious and expensive health condition. It would not make sense if we all paid for insurance and this person just purchases the policy after they have been diagnosed with an expensive medical condition? The solution is:
- One year Pre-ex clause for those young adults, ages 18 thru 21,
- Three year Pre-ex clause for adults
- No Pre-ex clause for children!
In summary, Regarding Portability, if a “takeover” provision is mandated on a “GI GR” basis, then portability is no longer an issue because everyone would now have the ability to buy a policy anywhere, anytime, without penalty due to medical conditions.