Who’s On First?


By Molly Mulebriar

Having nothing better to do this morning, I went back  through my medical / insurance records just to see how much I ended up spending out of my pocket over the past 12 years.

I have maintained a high deductible plan all those years through Blue Cross. My annual deductible is $10,000, after which the policy pays 75% up to a maximum out-of-pocket limit. I like the plan, and I have always been willing to assume part of the risk.

During this 12 year period, I had occasion to use the policy for a major health condition. Three in-patient hospital stays, a 5 hour surgical procedure, two trips to emergency room treatment, numerous follow-up visits with various specialists, and now check-ups every three months.

My out-of-pocket totaled $52,000. My insurance premium was $60,000, bringing my total cost to $112,000. If I had no insurance at all, my total cost would have been $80,000, or $33,000 less than it cost to have the insurance policy.

It would appear that the insurance company won, and I lost. But the truth is Blue Cross lost money on my policy in this instant. So that must mean I won, the insurance company lost. But wait, I could have saved $33,000 without the policy! So I lost! If I lost, Blue Cross must have won! But Blue Cross lost too! So Who won?

Actually, I have no complaints at all. Insurance is a risk transfer strategy used to indemnify against unexpected, catastrophic losses.  I would have been happy to have had no losses the past 12 years  in exchange for $60,000 in insurance premiums.


Editor’s Note: Molly Mulebriar is a forensic auditor/investigative reporter from Waring, Texas and a frequent contributor to this blog. www.mollymulebriar.org