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Last Post 10/11/2009 10:13 AM by  Ol' Ghost
Health Insurance and the Adjuster
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christian
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09/27/2009 4:30 AM

    For Months now we all have been listening to the debate on health care reform. As adjusters it would seem that this would be a mute topic given our industry. Of course, it's not. We all know how this works now, we cover everything out of our own pocket. If the goal is to insure those without insurance how will it effect "at will" and IAs.

    My question is how it will work in the future? Will IA firms be forced to provide coverage or pick up any expense? Will we as adjusters be able to pool our numbers for coverage?

    Will the insurance companies that we work for be forced to comply? How will FEMA address this issue with Flood adjusters?

    I'll be the first to acknowledge that I haven't a clue.

    Thanks

     

     

    mac3821
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    09/27/2009 9:21 AM

    I don't think there is a clear answer right now.  Something needs to be done to try to control the Healthcare costs in this country, however I don't agree with a government controlled system.  At this point only time will tell how it all plays out.

     

    Stu

    Stu MacDiarmid
    Tom Toll
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    09/27/2009 9:45 AM

    Christian, that is the problem, no one has a clue. This country runs on the greed factor now and that definitely includes Health insurers and pharmaceutical manufacturers. With the Democratic and Republican party unable to work together, no resolution containing any common sense will be handed down to us, the commoners.

    Success is not final, failure is not fatal: it is the courage to continue that counts.
    Ray Hall
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    09/27/2009 5:36 PM

    Malpractice has caused too many expensive test. Many doctors have an interest in the image clinics. We all  k now they give the expensive RX instead of a generic or another drug that will work. Its money.S ome of the top doctors in Houston will not take medic aid patients. I do not know the answer, but the cost is out of control. I am not for universal health care. I am now in the do nut hole for the next 2700.00 of out of pocket medical expense I fell into it last month when I spent $790.00 out of pocket.

    The think obama needs to have the TV newsfolks on site to photo the people who die each day from lack of insurance. I have not heard of any, but you know it must several hundred each day.

    I still do not have any answer, except just to not get old. I was never in a hospital until I was 54, but I caught up this year.

    mac3821
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    09/27/2009 11:11 PM

    My wife went back to finish up nursing school a couple of years ago and she did a major paper on Universal Healthcare.  I don't remember the number of people who die each year from a lack of insurance but they are absolutely staggering.  The biggest problem is not that people die simply from not having insurance but because they don't go to the doctor to take care of the small routine issues that lead to larger ones in the future......One instance I remember from her paper was a young boy who didn't go the the doctor or dentist with a massive tooth infection because he had no insurance.  Some 6 or 7 days later he died from a massive infection that started in the tooth and spread to his brain.

    This stuff happens every day and no one knows about how much could be avoided.  I for one can testify that my insurance premiums for me and my family started out 8 years ago at 298.00 per month for good BCBS insurance.  I just changed plans a few months ago and the last payment I made for my old plan was just under 1300.00 for that month.  My monthly premiums slowly increased over that time period over 1000.00 per month.  THAT is out of control.  The average persons house payment isn't even that much.

    I am going to quit now!  If I go on about this much longer my blood pressure is going to get up and I won't be able to sleep.  Ray,  I'm sorry to hear about you recent donations to the local doctors!  What kind of health problems have you had this year?

    Stu MacDiarmid
    Tom Toll
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    09/28/2009 10:21 AM

    Ray, I don't understand why you owe that much. My cancer surgery and resulting phlebitis ran almost $160,000.00 and I paid very little of that expense. Thank goodness for Medicare and my supplement provider. Medicare pays for all my COPD medication, has bought me a Jazzy mobility chair, and pays my Pulmonologist when I go to her.

    There are thousands of people that die needlessly every year because they do not have the money to pay premiums, therefore they do not have the money to see Doctors. This is, of course, a travisty and needs to change. I am in hopes that the politicians can get their animosity of each other out of the way and start working to help us peons.

    Success is not final, failure is not fatal: it is the courage to continue that counts.
    Ol' Ghost
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    09/28/2009 12:36 PM
    Please allow me to jump into the riduculous by opining I want my new medical plan bought at taxpayer expense to be the same one the congress gets WITH additional mental health coverage provided by several scantily clad dancing girls like the ones they have on the spanish language TV shows. I figure they would be a medically sound prescription to keep my 'morale' up.
    Jud G.
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    09/28/2009 3:17 PM

    I envision that it will be similar to the way the NFIP is run.  Consumers have the option to purchase flood insurance or purchase an alternative, manuscript policy from an overseas broker or get hit with a high cost, lender placed policy.  You as a taxpayer will still retain the option to keep your current policy, but the heavily subsidized NFIP policies typically destroy anyone else who decides to try to take a stab at competing.

    The only reasons why there are a few manuscript flood policies is because of limited coverage by the NFIP (I recall its still $250K  for dwelling and $500K for Com. structures) and some counties still don't participate with flood mapping. 

    The lender placed policies are somewhat competitive because they are retroactive and usually only cover for Covg. A and B items only.  Yet, even then, they can cost far more than your typical Homeowner policy.  In short, these (lender placed, flood policies) serve a unique and specific function.

    I suspect that these are where many of the similarities will begin when/if Healthcare is reformed.  We can still keep our current Health insurance, but most people will ask themselves why they should pay twice- once for private and a second time for your Public Option policy?  If reform occurs, I suspect that there will be some doctor's and care facilities that will refuse to participate for more work and mediocre pay.  This would be a reason to pay twice so that you can still opt to get the quality of care that the US Government just won't ever be able to posess.  We never heard Ted Kennedy ranting about how he wished he had Government doctors caring for him before he passed away, did we?

    This 'Public Option' semantic is simply an egregious act of deception so that our big Government President can make a power grab and convert the rest of our country into a socialist state of affairs.  Any attempt by private investors emboldened with the entrepeneurial spirit that started this country will be crushed by the heavily subsidized and mediocre government care.

    Somebody please tell me why Tort Reform is such a bad idea?  I know why it won't happen during this term, but isn't that really what the American public wants?  It's out of control Plaintiff attorneys that are a significant contributor of atrocious costs for R&D and Health Care.

    ChuckDeaton
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    09/28/2009 9:26 PM
    Posted By Tom Toll on 27 Sep 2009 09:45 AM

    Christian, that is the problem, no one has a clue. This country runs on the greed factor now and that definitely includes Health insurers and pharmaceutical manufacturers. With the Democratic and Republican party unable to work together, no resolution containing any common sense will be handed down to us, the commoners.

    It is called Capitalism.

    The fact is that most of those that do not have medical coverage never had medical coverage until they needed it and then found that pre existing conditions are not covered. A fact that is true of all insurance. Show me a property policy that provides coverage for damage done prior to the inception date.

     

    "Prattling on and on about being an ass with experience doesn't make someone experienced. It just makes you an ass." Rod Buvens, Pilot grunt
    ChuckDeaton
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    09/28/2009 9:46 PM
    Plaintiffs attorneys can't file a lawsuit without a client. Plaintiffs attorneys are advocates and capitalists and very seldom file lawsuits that cannot be won. No judgment, no income. That is the way capitalism works.

    Should you be maimed by the medical profession I guarantee that you will hire an advocate and should you be killed by the medical profession I guarantee that your family will hire an advocate. That advocate will review the circumstances, make a decision related to representation and then argue your case to a jury of your peers. What if your heinous damages are worth lots, but you can only receive a little because of liability caps.

    At this moment many Texans are hiring advocates and lawsuits are being filed over unsealed shingles. Should any recovery be capped?
    "Prattling on and on about being an ass with experience doesn't make someone experienced. It just makes you an ass." Rod Buvens, Pilot grunt
    okclarryd
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    09/29/2009 7:34 AM
    The next time I get sick, I'm gonna ask for the same room that Ghost has.
    Larry D Hardin
    Ol' Ghost
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    09/29/2009 10:52 AM
    That's okay by me, I just hope my snoring doesn't keep you awake.

    Ol' Ghost
    linhoch
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    09/29/2009 4:39 PM
    We could sell one aircraft carrier and it would pay for the first few years of public health care for the 40M of who have been priced out of the market. But who would buy such a behemoth or afford to fill the tank, besides Uncle Sugar, who cannot afford a public option because he is policing the world, so France and Britain and Canada can pay for their single payer systems? The picture is larger than just us capitalists standing on principle no matter how many fellow capitalists die before our eyes (at our own hands by omission) because their fellow capitalists will not defray another 100% profit increase this year. Perfectly sane and rational in a Colbert sort of way.
    okclarryd
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    09/29/2009 7:12 PM
    I'll just turn off my hearing aids.

    That's what I do when Olwhatsername gets on my case.
    Larry D Hardin
    claims_ray
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    09/29/2009 7:27 PM
    I think that both of you would be to tuckered out to care about the snoring.
    RandyC
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    10/02/2009 4:53 AM
    I've noticed a lot of the people that are against government paid healthcare have government paid healthcare. It must really be bad.

    I know all aspects of socialism and social collectives are bad; everybody knows that! Now explain actuarial risk pool again.

    I don't think the public or the politicians are ready to face the truth about our healthcare delivery system. I think the current talks are like a bunch of different people coming to a giant hornets nest with a stick. None of them brought a real plan, but they are all willing to poke a stick in the nest.

    That's my poke. I don't have a plan..just a stick.

    Randy Cox



    claims_ray
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    10/02/2009 10:44 AM
    If the US implements a Government run health plan we will have the same options as the Canadians. Go south for health care.
    Ol' Ghost
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    10/02/2009 1:25 PM
    South of the Border...Down Mexico way... That's where I fell in love, when stars above, came out to play!

    But, it was Fiesta!...And, I got the Clap...From a Canadian Seniorita who danced to close to my lap!

    The Mexican Doctor...Said lower your pants...This needle full of goats juice, will cure you fast!

    South of the Border...Down Mexico Waaay!!

    Ole!
    jdacree
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    10/10/2009 10:19 PM
    Just chiming in here. My wife and I were discussing the cost of health insurance, in the light of my becoming self employed. She railed against the current cost of employer sponsered plans, then really railed when I told her that self employed plans were even higher due to not having a pool to spread our risk through.

    Since the mid to late 60's many of the larger employers started generating health care coverage that allowed the employee to utilize a better class of health care at a much reduced, if not free cost out of pocket to him. Part of this plan was for recruting new employees utilizing a benifit that they could not get at their current employer or other like employers in their field. This started a race to see which employer(s) could provide the best benifits, at the least cost to the employee. We, the employee's benifited greatly, until we started looking at the bills that the insurance companies had paid to the medical establishment. I mean, really $7.50 a tablet tylonel is not even considered high by insurance companies for bills recieved. This race for improved benifits gave the medical establishment carte blanch to set and charge any rate that they wanted, and the patient never once was bothered due to having met his co-pay, if any, he never saw a due notice to him for the charges.

    It is my opinion that at some point the cost(s) of health care will cut into the guarenteed profits of the health insures to the point that the cost of health insurance will drive many of us back to the days of the 50"s. Back then our health insurance, the best you could buy, covered only severe health cases, surgery, or other items of this nature. The deductibles were quite high, and all other out of pocket costs for health maintenance were not covered. At this time in our health insurance history most of us saw the doctor rarely. As a group we seem not to have suffered significiantly. As with now, we had very large numbers of people that were not covered by health insurance, and each larger town or city had at least 1 "county hospital" that services the needs of the un-insured. When we reach that point, and as an example, I will have to revert to a HMO rather that PPP plan so that I can pay the premiums, we as a consumer of medical services will start shopping for the best deal. If and when enough of that is happening, we will start to see some reductions in medical costs. As with any industry, supply and demand sets the price structure, and provides the direction of prices either up or down.

    While not being politicially motivated, I fear that what we are feeling in health care is not unlike what most of the last 1-2 generations have come to expect. We can see in all spectrums of our daily lives a simple greed comprised of "What is in it for me", and "I am entitled". What is left out of this is What is in it for me, and I am entitled is a sense of earning without having to lift one damn finger to earn it. Sorry to be so long winded, but as the silent majority in some of the susprise elections of the past, it is time to clean house, in all spectrums, by saying I am tired of working to support all of those who will not.
    Jim Acree Stupidity is the art of not trying to learn Ignorance is the lack of opportunity to learn I am ignorant
    Ed Bailey
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    10/10/2009 11:04 PM
    Healthcare may be the best example since the federal reserve was established of how those with the big money control our elected officials. Instead of waiting to find out what is in the healthcare bill, we need to express how we feel about it to our representatives in congress. What do we want in the bill? What don't we want?

    When the Fedral Reserve was established, our government used the plan that was provided by the biggest bankers in Europe. Talk about the fox guarding the hen house!
    Similarly, the healthcare debate is being driven by those with the most to lose or gain monitarily. If you are for or against universal healthcare, let congress know exactly what it is that you are for or against. If we just wait to see what form the final bill takes, we have little right to criticize it.

    Don't simply trust your representatives to use good judgement. Instead, provide your good judgement for them to follow. The collective heads of the constituancy will always be smarter than an elected official.

    I believe that healthcare is the right of all US citizens. I also believe in personal responsibility. I could not support a healthcare bill that does not hold us allaccountable for our contributions to the plan.

    If that means that an unemployed mother of 5 would have to provide a service of value to her community, so that service reduces the operating cost of that community, so be it. It's time that we all have to pay to play.
    Ol' Ghost
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    10/10/2009 11:20 PM
    Thank you, Ed, for prompting our next poetic offering that references the example in your last paragraph.

    Ahem!

    There was once a lady who lived in a shoe,
    She had so many children she didn't know what to do,
    So she replaced her porch light with one colored red,
    And made a good living right there in her bed.

    Would you consider this yet another instance of successful capitalism wherein supply rises to meet a need without government interference?

    Ol' Ghost
    Ed Bailey
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    10/11/2009 9:06 AM

    Yea Ol Ghost.

    If she made her bed, she should have to to lie in it. The problem with that is there are two things in the air of that bedroom that can get her pregnant again. Her feet.

    The problem is the bed, not her. We can fix that. Stack ten mattresses on top of each other. At the top, she'd pray not to fall. This might remind her to kneel beside it occasionally too. Soul searching there might help to put her back on her feet.

    If not, she needs something bigger than a pea between the mattresses. I'm thinking........ a watermelon. That should make her uncomfortable enough to put her back on her feet.

     

    Ol' Ghost
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    10/11/2009 10:13 AM

    Good Morning, Ed. In our economic example here, Our Lady of Capitalism has started a small business without government aid and has become quite self sufficient. Business has thrived, income is up, she has moved her operations to more sumptious surroundings and the kids are enscounced in prefferred schools with generous allowances. She is happy with her progress in life from a government aided existence to self sufficiency and now philanthropic pursuits. Being one of the Catholic faithful, the additional offspring seems to fulfill her spiritually and besides, public figures like Octomom and Kate Gosslien with their broods justifies in her mind the large family concept.

    The question stands, do we as the body politic wish to provide a more collective controlled society for the likes of Ms Lady of Capitalism or do we wish to let one rise or fall based on the free independence of the individual? That is the basis of the current health debate. In a 'free capitalistic' society some must sicken and die if they cannot pay for medical repairs to their bodies. In a 'controlled society', one can sicken but the body politic will provide the medical repairs and perhaps delay death for a while.

    Being a 'free independent' the nice lady now has the money to pay for her own medical expenses, whereas before she was a ward of the state. Setting aside the legalities and moralities for a moment, has she not fulfilled the classic American Capitalistic Dream and is now no longer a burden on the body politic? If only we all could start a successful business, we too could stand tall and independent. Ya know, I got an idea just now. I think I'm gonna start a small business providing professional services to insurance companies during catastrophes doing property adjusting traveling all around the country. I bet I could then make a whole lot of money and be a beacon of hope to all I meet.

    Ol' Ghost

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