Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        About Health Insurance

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Our web site effort relates particularly to South Carolina, but much applies anywhere in the USA.

From then to now:

Paying the bills for health problems used  to be (prior to 1960) like shopping for anything else. Then (around 2010), health care became close to being a "right"...leading to ACA government programs...leading to a huge money infusion into "the system". As it turns out, "medical costs" are currently divided about one-third each between costs of (1) MEDICAL diagnosis & treatment, (2) medico-legal expenses ("defensive medicine"), and (3) administarative activites related to managing the system plus accreditation costs plus claims for payment management. As (1) patient expectations heightened, (2) malpractice  lawyers obtained huge judgements which caused doctors to practice "defensive medicine", (3) government programs proliferated & encouraged people to use "the medical system", and (4) explosive growth in expensive & highly advantageous technology entered the picture, costs to patients skyrocketed. Originally there were two parties in the transaction: the patient and the care provider (doctor, hospital, clinic). Because persons could be "wiped out" by sudden and unplanned health costs, third party payers entered the picture as vehicles to insure, prepay, or cover costs through various programs. In 2010, Obamacare was passed & will have enormous consequences...mostly unknown as of late 2010. But, Massachusetts set up its "Connector" in 2006, a strongly government controlled health insurance exchange to help cover all of its citizens through government supplimented health insurance. In September 2010, Utah opened its more free-market exchange.

NOTE: Did you realize that two religious groups see "insurance"...unless required by a form of wagering/gambling that also earns income by interest/usury? Many Amish and Muslims hold such a view.  

Your impact on costs:

You are not required to take every suggestion your doctor or any other provider might offer or want you to do. In fact, often by virtue of their specialty, they are prejudiced toward a certain approach or even deliberately or subconsciously biased. When not an emergency, see what it will cost. Don't be afraid to say, "I can't afford it; what are other options." And you can help yourself by learning how to have a healthier lifestyle,

Why insurance...what's it for?

The fundamental idea of insurance is to protect yourself against "wipe outs". The insurance "policy" is your health insurance contract, whether your coverage is obtained & carried through your employer (the company is the customer) or a group (the interest group is the customer) or personally and privately by yourself (you are the customer...and you will find that these contracts are often vague and/or hard for regular people to figure out). And you may need copies of specific wording in it. Typically, third party payers (the insurance program) pay a large part of many claims and you pay the smaller part. 

How much will insurance cost me?

The cost to you for insurance tends to be related to the riskiness of that 3rd party payor's total number of customers covered plus an estimate of how risky you are plus a company decision of an annual profit target.

Getting doctor & hospital bills paid:

Filing a claim is your responsibility & requires highly exact information. Many health care providers will file claims for you. SO, you must always provide the "provider" (doctor, hospital, clinic) with up-to-date insurance card information because many providers will provide claims filing services free to you, especially if you will help them to help you (see below)

Keep firmly in mind that, even though most citizens are not able to discern the complexities of the financial aspects of our health care system (and the third party payers know and count on this),  you have paid your premium in good faith in order to purchase the coverage! A high percentage of health-care providers will legitimately ask for entire payment of fees up front and take the responsibility of sending you a refund after they actually get your payment from the third party coverage. This has to be done because you have made the insurance company your agent, and those companies often hassle the providers (especially through means of multiple "delaying game" tactics). But, you might consider that all of business society elsewhere is sometimes willing to give a "prompt payment discount"...ask for it in exchange for prompt entire payment.

 Take the attitude (it need not be a confrontation) that a patient and the patient's providers all desire a long-term and pleasantly recurring relationship ( are the "customer") on out into the future. Providers even hope that patients refer other patients to them! Therefore, you should feel natural as you ask providers to disclose all of the ways they know of which can be a positive contribution to your financial & health advantage ("Have you got any tips on how I can save money on costs?")!

Finding the best health insurance:

U. S. News and World Report keeps a guide on its web site, HERE. Aetna & the Financial Planning Association  have launched a website to help educate you on looking for the best plan for you. The  S. C. Hospital Association web site has a "consumer info" button which links to a "glossary of health care terms" which you might find handy. California has a site with tips about dealing with HMOs. And there are Health Care Sharing Ministries. The American Health Information Management Association's web site has info explaining what the "medical record" is and your rights concerning the record (and a file of FAQs).


  Cardinal rule: never threaten using a lawyer or law suit (why? because the parties can't legally co-operate with you once you draw that line in the sand...they must then work through lawyers). If they will cooperate and be receptive, try to use your efforts in cooperation with your provider's billing department (most of whom file claims for you but rarely do much actual "fighting" in your costs them too much in personnel time to take on a fight...think of that billing office as a sort of "coach" who can advise you on what you can do to help your cause). The providers and their billing and social worker services are your friends and partners.

(posted Aug. 2001; latest addition 15 July 2014)

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