Insurance Reform:

Insurance Coverage Options

Presently, most medical insurance policies come with a lengthy list of what is covered and what isn't. Most insurance customers can't even pronounce the words describing some of the medical treatments discussed, much less realistically evaluate whether or not they need insurance coverage for them. Worst of all, these lists make it extremely difficult to compare the coverage from one insurance company to the next. Experts suggest customers make sure they fully understand their policies, but this is unrealistic in this case.

A better idea: Abolish the entire idea of listed coverage. It's a bad idea anyway, customers cannot predict which item they will need coverage for, and once they get sick they are gonna be real unhappy when the insurance company informs them that such-and-such is not covered.

Instead, let's divide coverage into basic types. I can suggest three basic divisions: minimal, complete, and unlimited. If the customer chooses the minimal coverage and gets sick or injured, the insurance pays to fix him up in the cheapest way possible, no frills. Under complete coverage, the insurance must pay for state-of-the-art treatment, the type Americans are accustomed to. And under unlimited coverage, the insurance company must even pay for experimental treatments, and possibly even for travel abroad for treatments unavailable in the US. These three types of policy can be fairly easily defined so as to be clear to the customer.

An example may clarify the distinctions: Let's say the customer comes down with inoperable cancer, and will die after a lengthy illness. If the insurance chosen is minimal, the patient goes home and is cared for by relatives, with the insurance providing some painkillers. If the coverage is complete, the patient stays in the hospital or is sent to a full-service care facility at insurance expense. If the coverage is unlimited, the patient can insist on experimental surgery, non-FDA-approved treatments, etc.

Each policy, regardless of type, will also have a dollar limit.

The customer, when shopping for insurance, only needs to compare the type of coverage and the dollar limit to find the best insurance for his needs and budget. He no longer needs a degree in medicine to understand what he is signing. All policies, regardless of type, will cover any and all medical problems he may encounter.

The insurance companies will also benefit from the clarity, in that they will no longer be subject to lawsuits for treatments the policy doesn't cover. If the patient feels he has a right to experimental treatments, he must pay for that coverage; if he chooses not to, it is clear to all that the insurance company is under no obligation to provide them.

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Of course, if you have questions or comments, you are welcome to send e-mail to me at  palmk@nettally.com.