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Dynamic Chiropractic – August 2, 1991, Vol. 09, Issue 16

The Legacy of Insurance -- Part III

Half the Insurance at Twice the Cost: That's a Bargain?

By Walter R. Rhodes, DC, FCCC
Insuring half the person at twice the cost is becoming altogether too common. You have surely heard it said that "after five years the rider can be removed for certain conditions." What you will not hear so often is that the removal is rarely automatic. What you get after a period of time is the privilege of asking the company, in writing, if they will consider its removal. Few people ever tag their calendars five years ahead to remind them to make such a request and without it the rider is still in force. Even with it, removal is usually a company option.

Rising Costs in Medical Care

Insurance, almost alone, is the factor contributing to the inflated wealth of the medical and hospital communities. If doctors and hospitals could charge only what their patients could and would pay out their pockets, the cost of a doctor's visit and a hospital stay would be drastically reduced.

Insurance makes it possible for the doctor to be separated from the patient's ability to pay. Plus, a patient's complaint of overcharges or being charged for services not rendered will usually fall on very deaf ears because, simply put, the carriers are also separated from the individual patient's specific complaints. They get their money without being responsive to demands or requests by their insureds.

What Taxes Pay For

When you consider that the hospital research, the training programs for both doctors and nurses, the office space, the equipment, the original construction, and much of the day-to-day operational expenses are, in large part, being paid by either federal or local tax dollars, then, the pay problem becomes much more clear in perspective.

Who's Worth $45,000 Per Day

A surgeon, for example, doing ten surgeries in one day at $4,500 each grosses $45,000. His net is about the same because private insurance or the government, at one level or another, pays for expenses, his place of work, his assistants, and his equipment. Is he overpaid? Reach your own conclusion ... but not before you realize his education was mostly paid for by tax money and the bills of his Medicare patients are also paid by tax money. He will speak of his "sacrifices" during the long years of schooling, but there are millions of people who regard his sacrifices as extreme good fortune, mostly paid for by taxpayers. Opportunists would be a better description than sacrificial lambs.

The Bedrock Foundation

At the base of all insurance is trust. Trust that money will be available to cover losses, and trust that the money will be paid. The carriers are about to skewer themselves on this very point because they so often deliberately deal in bad faith with their claimants.

They have both the right and the duty to investigate claims, but once their liability is established a whole new world is uncovered that insurance salespeople never mention. Under the instant adversary relationship it seems to become the duty of insurance adjusters to close claims as cheaply and as quickly as possible -- no matter the loss, no matter the terms of the contract, and no matter how low they must dip in the bag of dirty tricks.

Questioned Under Anesthesia ... Or Heavy Sedation

Getting statements from accident victims while still under the influence of anesthetics is a neat trick, especially when the first time the victim discovers it is in court and they don't even remember ever seeing it before, but the signature is theirs.

Under such circumstances they would probably also sign papers affirming that they were Superman's parents and/or that they personally wrote the Constitution of the United States. Just as bad, but in another arena, concerns the hiring of officers and board members of affected organizations as "reviewers," thereby creating an insurmountable conflict of interest which renders the opposition of the organization ineffective. The officers won't move against their own financial interests and haven't the insight to see that they are being used, soon to be cast away themselves.

How Could They Even Find Out Without Cheating?

Studies have been done where the carrier pays only 80 percent of what they owe and send it with no comment. Most people just accept that amount without complaint. That's a real profit-making gadget. There are few businesses which couldn't thrive on an addition of 20 percent to their profit margin. Another one is to lose the file about three times. Unless there is a lot of money at stake, many people forget it. Another is to deny the claim with a nonsensical explanation. Another is to make a ridiculously low offer, usually combined with the threat to "not pay any of it if contested." Entire books have been written on the dirty tricks topic and many are still in print.

The Aranda Decision and Other Bad Faith Items

The legal forum is now blossoming with carrier blood. The Aranda Decision from the Supreme Court of Texas established that all insurance contracts, including workers' compensation, carried an implied obligation for the carrier to deal with insureds in "good faith" and further established it to be a tort action separate and apart from the contract's requirements to which the carriers are subject if they do not so bargain.

Walter Rhodes, D.C., F.C.C.C.
Fort Worth, Texas

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