Illustration By Dutch Rojas – The Rojas Report
By Bill Rusteberg
Health insurance is a reimbursement benefit for a covered loss. Although plan members each pay the same premium, some receive greater benefits than others.
Under status quo legacy health plans some plan members are reimbursed more than others for the same service. That’s discrimination.
Indemnity plans, on the other hand, bring equity to health care. Examples of indemnity plans include Medicare, Medicaid, and Workers Compensation Insurance. Reference Based Pricing plans are indemnity plans too.
Meanwhile status quo legacy health insurance schemes continue to discriminate. For example, Joe Sixpack is reimbursed $375 for his MRI while Mary is reimbursed $4,500 for hers. Joe should scream “DISCRIMINATION!” and demand the difference
If both were on an indemnity plan both would be reimbursed the same amount for the same service or procedure. But they’re not, they are on a PPO plan.
Of course none of this matters in the eyes of plan members because invariably they sign over their claim collection rights to medical providers through an Assignment of Benefits. This is a form of free credit, freeing plan members from paying first, collecting later.
If plan sponsors were to prohibit Assignment of Benefits plan members would, for the first time ever, begin shopping for best pricing for their health care needs just like they do for everything else. In the example above poor Mary would have to come up with the difference between the cost of her MRI and Joe’s MRI…….. Mary, you owe $4,125! (That’s called a Balance Bill).
Officials at the EEOC would be ecstatic at the elimination of rampant health insurance induced discrimination affecting working Americans everywhere.
Remove the Assignment of Benefits provision from your plan document and watch what happens. In the alternative move from a traditional status quo health plan to a Reference Based Pricing plan wherein plan members and medical providers alike are treated equally.
ADDITIONAL HOMEWORK READING ASSIGNMENT: Hospital Cover Charges & Whore House Financing-
