How Insurance Companies Medical Providers and Drug Companies Game the System

March 5, 2019 – For those feeling beat up, picked on, and maybe even a bit bullied by their doctor, hospital and health insurance company there is probably good reason to believe that way. Doctors and hospitals are charging more for services and insurance companies are denying more claims.  Patients need both their health care providers and insurers, but as respected neurologist and Houston Healthcare Initiative Co-Op (www.houstonhealthcareinitiative.org) founder Dr. Steven Goldstein tells his podcast audience, this is not a normal ‘business-customer’ relationship.  The Houston Healthcare Initiative Co-Op podcast can be heard on Soundcloud, iTunesand the web site at www.houstonhealthcareinitiative.org.

Human Shields

The Houston Chroniclereported that ‘doctors and insurance companies have proven they are willing to use patients as ‘human shields’ but what were they really saying? According to Dr. Goldstein, “the conflict is about money.” Dr. Goldstein told his audience that the insurance companies wanted premiums to be as high as possible. But the blame does not stop with the insurance company. “Doctors and hospitals want to charge whatever the traffic will bear,” he said. “A system has evolved that benefits insurance companies, doctors and hospitals but is to the detriment to the patient.”

How Doctors and Insurance Companies Do It

Here is how patients get screwed: Very high list prices for various services have been set up by hospitals and doctors. Insurance companies negotiate contracted prices for these services that are significantly less than the list price and they claim these negotiated rates have benefited the patients, “Anyone selling something can claim a high price, but then list the item as ‘on sale’ for a price that is much less and make it seem like a big savings but it is a big fake out,” he said. “That is what the insurance companies are doing to you.”

Human Piñatas

When hospitals are forced to compete in the marketplace, the market determined cash price for just about anything they offer is usually much less than the insurance company negotiated price. “Less than a shield, patients are used more like piñatas who take a beating from both the hospital and the insurance company,” Dr. Goldstein said. But according to Dr. Goldstein, there are more sensible things people can do to protect themselves and save money.

The Insurance Alternative

Alternatives to traditional health insurance are available from medical co-operatives, or co-ops. The Houston Healthcare Initiativeis a member owned, non-profit medical co-op. It will replace traditional health insurance for qualified individuals, families and provides incentives for members to adopt healthier lifestyle habits. The medical co-op promises to provide more value for the healthcare dollar. “At the same time, we will help uphold quality care by asking members to bear some responsibility and individual accountability for maintaining their personal health,” Dr. Goldstein said.  “It removes the insurance company from the relationship between doctor and patient, thus getting rid of all that expense from administering insurance,” he said.

In the medical co-op model, people pay directly for their care at the cash rate. Large hospital expenses are reimbursed by the co-op trust. “Thus, in one fell swoop, a big piece of what is wrong with the healthcare industry is removed from the equation,” Dr. Goldstein concluded.

About Houston Healthcare Initiative Co-Op

The Houston Healthcare Initiative Co-Op is a member owned, non-profit cooperative owned by the members. To learn more visit them on line at www.houstonhealthcareinitiative.org.