Health care: So you think you're covered?

Do you like your health insurance plan? Do you feel secure?

Do you know what Narrow Networking is? If you don’t, it most likely will discover you, sooner rather than later.

Do you know that the health insurance companies are betting against you?

Clearly that is the reason that they often act to make you angry and miserable with their actions and decisions. They gladly will accept your money. Guess who holds all of the cards?

If you are involved in an automobile accident, metal, rubber, leather, and plastic can always be replaced. Your good health and quality of life cannot. A quick glance at your automobile policy will often reveal 2 or 3 pages, with written numbers. On the other hand, how many of you have tried to understand all of the ramifications of your health insurance policy? Forget it! You are dealing with corporations that openly choose to challenge logical decision and human compassion to fit the profile that they feel comfortable with. And guess at whose expense?

So, you have purchased a health insurance policy that covers you, less your deductible of course, for every malady. And, you are not yet eligible for Medicare. You now feel secure and safe in your decision making. Perhaps, you do, but should you? Narrow Networking may be lurking just around the corner, with the insurance company sitting in the driver’s seat.

Keeping an open eye, who among you have not seen or heard of individual medical practices disappearing with ever increasing rates? Quality and needed medical talent is disappearing and doctors often retiring by the day. Hospital corporations for the most part purchase these entities, only to form giant and cold medical groups, with providers (do you remember when they were called doctors?) who run from examination room to examination room, mostly in shortened patient visits. And most all have computers in their hands, and are seen to be typing and clicking, if only to satisfy the insatiability of databases and electronic medical records. Some refer to this as mindless monkey work. Of course there are some private practices that band together for the sake of survival, but the majority is now hospital owned.

And now to feed the beast. Enter the healthcare insurance companies and the Narrow Networking model.

More and more hospitals and their medical groups are signing agreements with the insurance companies to offer care for their patients, in individualized and designated areas. And other designated areas have their own Narrow Networking areas as well. But why should you care, for you have your own individual insurance policy to protect you. Not a problem! In reality, you should be getting a bit concerned as you see your premiums increasing yearly, along with higher deductibles. But after all, were you not told that health care is becoming more affordable for all? And we haven’t even gotten to “if you like your doctor, you can keep your doctor, and, if you like your plan, you can keep your plan.”

Are you aware that your insurance company might not cover you, the patient, if you cross to another area or network, without a proper referral made to the insurance company? You have to be feeling restricted by the rules of the insurance companies by now. Are you now questioning if you are slowly or perhaps not so slowly being forced to accept care where and with whom they say you should go to? Under this type of plan, patients are being forced to find and register with a provider in their own network and area. In most cases, a patient may go outside the network, but be prepared to pay much higher fees.

What happens if your longtime trusted physician is now located outside your network? Perhaps being located but a mile away, or even across the street? You may also ask, what if you are in further need of a specialist, who is in another network that you are not registered in? Not to worry! You can always appeal to the insurance company, which will make the final decision to offer or not to offer you the coverage that you expect. And we all know how that might go.

Do you feel herded? Is this the direction that health care is going?

Suppose a patient follows the rules, and agrees to see a provider in the assigned medical network. And in continuing, just suppose the patient needs the care of a specialist. Yes, you may receive care from a specialist within your own group, usually without a problem. But what happens if the patient is in need of individualized care from a different specialist outside your network? This specialist may be located just up the road, or even a considerable distance away. Perhaps this specialist with their expertise may offer the patient a better outcome. Fear not, for you all realize that you may place an appeal with the insurance company. Once again, guess who makes the final decision?

So few of our population fully realizes the direction that this road is taking, or that it may be in your own community. You as a patient may not yet be walking on this road, but it does exist and is probably just around the corner. The insurance companies are a for-profit organization! Never forget that! And you all should question and realize at whose expense.

So many people merely walk around daily, sucking their thumb, feeling safe and secure. Just know that “in the land of the blind, the one-eyed man is king.” It all depends on how a person defines their freedom. The younger generation, generally by virtue of their youth, are usually not as affected. That is until they mature more, and things indeed start to happen. As a person ages, they certainly do not wish to become a burden to society. The end result can be frightening, especially as the population figures increase. I am reminded of an older movie called, “Soylent Green.” Viewing it again may truly cause reflection and closer attention, even though it is based on science fiction.

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Win Steiger, M.D., is a Coeur d’Alene resident.