“It’s Not Insurance”
What You Need to Know About Health Insurance
What we have been led to view as health “insurance” doesn’t come close to meeting the legal definition of insurance.
Yes, it distributes costs across the general population as insurance is designed to do. However, the requirement for a signed contract between the insured and their insurer doesn’t exist. The only signed contract in the healthcare insurance system is the one between the so-called insurer and their in-network doctors, hospitals and other providers of healthcare products and services.
Contracts, better known as Provider Agreements, are deliberately hidden.
Contracts essentially subcontract the actual delivery of healthcare to the insurer’s in-network providers. And those contracts very clearly make a supposed healthcare insurer a PROVIDER of healthcare rather than an insurance company.
For while an insurance company requires that a healthcare bill be sent directly to us for payment and our insurance company reimbursing us for the cost of the expense, our so-called health insurance requires the very opposite. It requires all in-network healthcare bills be sent directly to the insurer for payment. In other words, it’s their bill not ours!
And, their SECRET Provider Agreements state exactly that.
Furthermore, any subsequent billing we receive is severely restricted by those very same SECRET Provider Agreements that we are not allowed to see or understand.
So, in truth, what we are asked to view as health “insurance” is no more insurance than a membership at our local YMCA. In fact, the best description for what we have is a membership in a “plan” that subcontracts the delivery of healthcare to their in-network doctors, hospitals and other providers of healthcare products and services. And, just like a membership at the Y, so long as we, or our employer, pay the monthly membership fee, we are entitled to use what the plan offers. However, unlike the YMCA, our healthcare plan reserves the right to lock the door to the care and coverage we need whenever it chooses.
And, for those who still have doubts as to whether your health insurance qualifies as actual insurance, consider the fire insurance on your home, flood insurance, or your automobile insurance. All these examples of true insurance provide a contract (policy) signed by you and the insurance company that states exactly what you are owed in the way of coverage. Furthermore, it’s a legally binding agreement you can enforce through the courts.
I challenge anyone to point to any such document in what we are asked to view as health insurance.
Making the situation even worse is that unlike all forms of true insurance, our so-called health insurance doesn’t have a definable end-game. For, while auto insurance, fire insurance, or whatever form of true insurance you pick, is contractually required to compensate us for our financial loss, our so-called health insurance has no such obligation. The need for a replacement knee, treatment for an injury, a flu shot, cancer treatment, prenatal care, or any one of the healthcare industry’s 77,000 separate codes for the care we receive can’t be equated to a financial loss. The care we need is purely a relative determination to be made by “our” doctor. In fact, it’s a determination aimed solely at making us as well as possible outside any consideration of cost or financial loss.
In short, our supposed health insurance isn’t insurance at all. Because, if it were insurance:
We would owe whatever isn’t covered/paid on a bill
Our insurer would be liable for any failure to deliver the care OUR doctor prescribes as medically necessary.
Clearly not true on either count. And, so we find ourselves at the core of “The Big Lie in My Healthcare Bill” and a book by the same name. But, that’s a discussion for another day.