Greetings Policyholders,
There are cautious people in the world who say they never
bet on anything. Just for fun, I always ask if they have
insurance coverage. Isn't insurance simply a bet with some
company that a really terrible something is going to happen to
you? At least, that's the only way you would ever make out on
the deal. If we could be sure that nothing would ever happen to
us, insurance agents would be forced to find more useful
employment, such as plumbing. Agents work a lot like bankers -
just as a banker is perfectly happy to lend you an umbrella as
long as it isn't raining, an insurance agent is happiest when
issuing a policy on something that could never happen. It is
pretty simple to get a flood insurance policy when you live on a
mountain top, but just try to get one if you live next to the
river. This also explains why the 25-year-old race car driver
can get life insurance easily, but the 76-year-old gent whose
major hazardous activity is taking out the trash can't.
How did we get to the current health insurance "system" here
in the U.S.? The answer is long and involved - and reads like
the minor clauses of an insurance policy, so we'll skip it.
Doesn't everybody skip the fine print? Even without the details,
several things are obvious: doctors hate the current system,
patients hate the current system, even insurance companies say
they hate it. Somebody isn't telling the truth, I think. Since
these same insurance companies have made billions in profit under
the existing plan, it is hard to see how they could hate it all
that much. Until they have to pay out, of course.
In addition, most of us feel about insurance salespeople the
way we feel about herpes, root canal and unwelcome relatives. I
think most of us would like insurance agents more if they didn't
act so much like bookies. When they are trying to get you to
pay, the insurance folks are always around, always anxious to
push another policy. But just try and find them when you have a
claim. When you do finally track them down, the companies always
have a few hundred reasons why they shouldn't have to pay off.
You mean you didn't read the fine print?
It's always been our policy to say Thanks to the folks who
contribute to SUNFUN, this week including: Bernie Becwar, Nnamdi
Elleh, Jerry Taff, Helen Yee, Tim McChain, Fumiko Umino, Tom &
Michelle Stricker, Tomoko Naito, Chuck Maray, Caterina Sukup,
Bruce Gonzo, Anna Macareno, Catherine Cassidy, Michael P. Miller,
Joel, Kristan, and Benjamin Conrad, Kerry Miller, Jan Michalski,
Yasmin Leischer, R.J. Tully, Carol J. Becwar, Judy & Major
McCallum and Joshua Brink. Sometimes I think that the only way
to make the insurance game pay off is to have your health
coverage and life insurance with the same company. That way, at
least, they have some incentive to keep you alive.
Have A Claim-Free Week,
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Miller's Law of Insurance: An insurance policy covers
everything except what actually happens.
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YOU GOTTA QUESTION?
------------------
Frequently-Asked Questions About Health Care
Q. What does HMO stand for?
A. This is actually a variation of the phrase, "Hey, Moe!"
Its roots go back to a concept pioneered by Doctor Moe
Howard, who discovered that a patient could be made to
forget about a pain in his foot if he was poked hard
enough in the eyes. Modern practice replaces the
physical finger poke with hi-tech equivalents such as
voice mail and referral slips, but the result remains
the same.
Q. Do ALL procedures need to be pre-certified?
A. No. Only those you need.
Q. I just joined a new HMO. How difficult will it be to
choose the doctor I want?
A. Just slightly more difficult than choosing your
parents. Your insurer will provide you with a book
listing all the doctors who were participating in the
plan at the time the book was printed. These doctors
basically fall into two categories:
1) Those who are no longer accepting new patients,
and
2) Those who will see you but are no longer part
of the plan.
But don't worry -- the remaining doctor who is still in
the plan and accepting new patients has a conveniently
located office just south of Skagway, Alaska.
Q. What are pre-existing conditions?
A. This is a phrase used by the grammatically challenged
when they talk about existing conditions.
Unfortunately, we appear to be pre-stuck with it.
Q. Well, can I get coverage for my pre-existing
conditions?
A. Certainly, as long as they don't require any treatment.
Q. What happens if I want to try alternative forms of
medicine?
A. You'll need to find alternative forms of payment.
Q. My pharmacy plan only covers generic drugs, but I need
the name brand. I tried the generic medication, but it
gave me a stomach ache. What should I do?
A. The HMO recommended treatment for this condition is to
poke yourself in the eyes.
Q. I have an 80/20 plan with a $200 deductible and a
$2,000 yearly cap. My insurer reimbursed the doctor
for my out-patient surgery, but I'd already paid my
bill. What should I do?
A. You have two choices. Your doctor can sign the
reimbursement check over to you, or you can ask him to
invest the money for you in one of those great offers
that only doctors and dentists hear about, like
windmill farms or frog hatcheries.
Q. What should I do if I get sick while traveling?
A. Try sitting in a different part of the bus.
Q. No, I mean what if I'm away from home and I get sick?
A. You really shouldn't do that. You'll have a hard time
seeing your primary care physician to pre-certify your
visit to a specialist. It's best to wait until you
return, and then get sick.
Q. I think I need to see a specialist, but my doctor
insists he can handle my problem. Can a general
practitioner really perform a heart transplant right in
his office?
A. Hard to say, but considering that all you're risking is
the $10 co-payment, there's no harm giving him a shot
at it.
Q. What accounts for the largest portion of health care
costs?
A. Doctors trying to recoup their investment losses in
frog hatcheries and windmill farms.
Q. What will change if the government takes over health
care?
A. Your coverage will have the efficiency of the Post
Office, the bedside manner of the Internal Revenue
Service, and the ethics of Congress. In other words,
it can't get much worse than it is now.
Q. Will health care be any different in the next decade?
A. No, but if you call right now, you might get an
appointment by then.
- David Lubar
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REMEMBER! NEVER VOLUNTEER...
--------------------------
"When I was working at Cornell University, I was amused
to discover that one of the benefits was a "Voluntary
Death and Dismemberment Plan." Even after it was
explained to me that this was an insurance plan (not a
direct benefit), I still wasn't sure when they would
pay a claim."
- A Cornell Professor
[ On your voluntary death, maybe? ]
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WELL, THAT EXPLAINS IT...
----------------------
Hospital franchises are growing at an astonishing rate. No
longer do we have a separate East Armpit Memorial and St. Francis
the Unwashed Hospital - all of the facilities in a community are
now often part of the same "health network." We assume they mean
healthy for the investors, since it hasn't done much for the rest
of us.
One of the largest, Columbia Health Care, now has 348
hospitals, over 285,000 employees and is involved in 35 to 50
takeovers a year. Being run like a retail business, CHC
hospitals are expected to maintain a 20% yearly profit. To meet
that goal, some of the hospitals have been laying off staff and
cutting unnecessary luxuries like emergency rooms and obstetric
clinics. They expect that there are no profits in kids and sick
people. The high profit patients they really want to concentrate
on are allergy sufferers and people with low back pain. These
patients never get better, but aren't sick enough to require
expensive treatments - the perfect retail-quality health
consumers.
"Somebody has to do in the hospital business what McDonald's
has done in fast foods and what Wal-Mart has done in the
retailing business," says co-founder Richard Rainwater. "Is any
fast food restaurant obligated to feed everyone who shows up?"
[ The very first time any doctor asks me if I
want fries with this treatment, I'm out of
there! ]
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I'D WALK A MILE FOR AN INSURANCE PLAN
-------------------------------------
Call it business insurance with an ethnic twist.
The 7,000 camels of Khuzestan are vital to the economy and
transport of the region. So the Iranian government recently
announced a novel insurance plan for the valuable beasts of
burden.
The daily Iran News said the policy would protect the
camels' owners against loss by earthquakes, thunder, snake bites,
floods and collisions with cars or other vehicles. Insurance
premiums will be split between the camels' owners and the
government, with greater premiums and payouts for older animals.
(Reuters)
[ There is, unfortunately, no coverage for
spitting. ]
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THE MAN WHO WAS HIT TWICE
-------------------------
Pub landlord Norman Green got hit twice in the same bus
accident. Oh, the First Leicester Transport bus only knocked him
down once, but he certainly got slammed a second time in the
accident.
The 51-year-old Green stepped off of a curb and suffered
four broken ribs when the bus ran over him in Leicester city
center. On receiving his letter asking about payment for damages
for his medical expenses and the 14 weeks he was off of work, the
company responded immediately. They billed him $845 for damages
to the bus, including a broken light and cracked windshield.
Silly Norman, he thought they were going to pay him.
Insurance manager for First Leicester, Tony Lambell, said:
"This accident happened because Mr. Green was not looking where
he was going."
The bus company did say, however, that it was suspending the
demand for payment until Green's finances picked up. (Reuters)
[ Yeah, they're all heart, aren't they? ]
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LIMITED COVERAGE...
----------------
Three doctor died and found themselves standing in front of
the pearly gates of heaven.
"So why do you think you should get into heaven," St. Peter
asked.
"I was a pediatric surgeon and helped repair kids
deformities," the first said. He was admitted.
"I was a psychiatrist," the second doctor said. "I helped
people rehabilitate themselves."
"You can enter, too," St. Peter said.
The third applicant stepped forward and said, "I was a HMO
plan manager. I helped people get cost-effective health care."
St. Peter looked at his book carefully before speaking.
"You can come in too. You've been admitted to heaven, but only
for three days. After that, you can go to hell."
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FUNNY COVERAGE
--------------
Liability suits are not funny.
That's what a group of circus clowns were told at a recent
convention in England. The official funny folk organization,
Clowns International, is quite concerned about their members
being sued for their normal clowning around by folks who don't
get the joke.
"With an increasingly litigation-crazy public ... the ethics
and legal implications of 'splatting' and 'sloshing' are expected
to be hotly debated under the Big Top," the organization
announced in a statement - perhaps the only press release ever to
discuss "sloshing" seriously. Makes you wonder how you get an
insurance agent to add a pie and seltzer rider to your policy,
doesn't it?
No clown has yet been sued by any victim at the wrong end of
a custard pie, but the organization fears it may be just a matter
of time. So they have a carefully devised set of rules they
expect members to follow.
"Only fellow clowns and celebrities should be chosen [as
victims], a white-faced clown must never be hit, and careful
judgement should be used to ensure that those targeted are not
averse," said Martin "Zippo the Clown" Burton, the group's
honorary vice-president. (Reuters)
[ They've even had to get liability and
comprehensive coverage on that little clown
car. ]
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HOW IT WORKS
------------
Larry's barn burned down and his wife, Susan, called the
insurance company.
Susan told the insurance company, "We had that barn insured
for fifty thousand and I want my money."
"Whoa there, just a minute, Susan, the agent replied.
"Insurance doesn't work quite like that. We may pay up to the
face value of the policy, of course, but the insurance company
only pays what something was really worth. In other words, we
just pay for a replacement of the same value, not the total
amount on the policy."
There was a long pause while she considered this. Finally
Susan replied, "Then I'd like to cancel the policy on my
husband."
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© 2001 by Bill Becwar. All Rights Reserved.
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