Shin splints, a common overuse injury, can cause significant pain and discomfort for athletes and active individuals. Characterized by pain along the inner edge of the shinbone, shin splints often,
Health Care Companies Don’t Care About Your Health
December 23, 2015 7:53 pm / Category: Wellness
You are wasting your money, and you’ve been at it for a while now.
I’m talking about health insurance. Legally everyone has to have it, but really, what has your health insurance done for you lately? Odds are: not much.
The Issue with Insurance
Most people won’t get through their deductible this year, and a large population won’t even see a specialist at all. So, if you paid your $1000 monthly premium (the average family price) and were relatively healthy this year, you’ll have paid your insurance company more than $12,000 with little-to-no benefit in return (And remember, health insurance is not like cell phone minutes—there are no roll-over programs for unused premiums.) This scenario is exactly what your health insurance company hopes will happen.
Every day you are inundated with television commercials, social media ads and mailers sent to your home from big health insurance companies, such as UnitedHealthcare, Kaiser and Blue Cross. They want your premium, and it must be pretty big business since these companies spend hundreds of millions of dollars just to get little ‘ol you as their client. Obviously you’re valuable to them, and they clearly want you as a member, so why do they make it so difficult for you to actually use your benefits once you are a member?
The Cyclist and the Insurance Company
Quick story. Most of you know that Rausch Physical Therapy is the premiere place to rehab injured cyclists in Orange County. Well, we recently had a patient fresh off knee surgery (Let’s call him Joe.) Joe’s a young guy, great cyclist, and he was more than eager to get on the road to recovery so he could get back on the road—an ideal physical therapy patient. There was just one issue: Joe’s insurance. UnitedHealthcare only allotted Joe six PT visits post-surgery. That’s it! Six visits gets him three weeks of therapy; that’s barely enough time to get Joe to bend his knee all the way, let alone get him back on the bike.
Now, here’s the kicker: his insurance company, UnitedHealthcare, has its own professional men’s and women’s cycling teams. That’s right, UnitedHealthcare pays $10 million every year to put its name on a blue cycling kit, but refuses to pay for the PT Joe the Cyclist needs to get back to cycling. Joe’s monthly premiums help UnitedHealthcare pay for its sponsorship costs, and in return UnitedHealthcare limits Joe’s coverage. How is UnitedHealthcare taking care of Joe’s health at all in this situation?
How Insurance Companies “Manage” Your Care
To be fair, UnitedHealthcare is not the only offender in this insurance game. Recently Anthem Blue Cross (BC) sent out letters to its constituents notifying them that it had hired a company called OrthoNet to “help manage” their physical therapy benefits. Reading between the lines, “help manage” really meant “to help limit your right to direct access to PT and the benefits you pay for each month.” Luckily for BC members, this plot never had the chance to come to fruition because OrthoNet has been sued and brought up on charges in other states for arbitrarily limiting benefits to the members it had been hired to “help manage.”
So, why would BC hire such a bad egg? What was in it for them? Combine the OrthoNet debacle with Joe’s story, and it suggests that it turns out your health insurance company is not really interested in your wellness, but rather in its bottom line. Health insurance should not be this way! The people whose hands you put your life (and money) in should be about supporting and restoring your health, plain and simple.
Okay, Quick Recap…
- You have to have health insurance.
- Companies spend millions of dollars made up of your paychecks to try to get new clients instead of to pay for your care.
- They don’t want/plan to actually pay for your health care, and they will try whatever it takes to not pay the providers that do care for you.
How to Beat the Insurance Game
Now I know this sounds like a lot of negativity, and sometimes it’s overwhelming to think about the frustrating state our health care system is in. However, there are a few things you can do to fight for your health and improve your well-being.
- Think ‘prevention’ and avoid unnecessary copays. Exercise every day, do yoga every week, get a massage every month, and eat well at every meal.
- Never let your insurance limitations limit your care. Most providers genuinely care about their patients’ well-being, and they will try to come up with a way to work around your insurance issues, such as a cash pay discount.
- Get the care you need, then demand payment from your insurance. While your provider will do its best to help, ultimately it’s up to YOU to get payment from your insurance company. As their client you’ll have a lot more pull in that conversation.
- Report any insurance issues to the California Department of Managed Health Care. Don’t be shy; these guys are here to help, and it’s the only way your insurance company will ever be held accountable. Click here for the forms you need to file a complaint.
So be proactive. Nurture your wellness daily, and demand access to the care you pay for and deserve. Don’t be intimidated by your insurance company; we’re here to help.
All the best to you and your family this holiday season and upcoming year.
Stay healthy and run faster,
As the president and founder of Rausch Physical Therapy & Sports Performance, Kevin Rausch, PT, MPT takes great pride in the care of every single patient he treats. Kevin specializes in sacroiliac joint dysfunctions, running and cycling injuries, and return-to-sport planning for athletes. Since the first day he opened his clinic in 2006, Kevin has strived to provide the best in care, service and technology so as to strengthen his patients’ total body health and get them back to doing what they love.
