“DENY DEFEND DEPOSE.” Those were the words etched across the bullet casings in the murder of UnitedHealthcare CEO Brian Thompson, and they’ve been recited countless times as our country grappled with the fallout of such an act.
Those words were inspired by the work of Jay Feinman, author of the 2010 book entitled Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It. Jay joined Jean Chatzky on the HerMoney podcast to talk about why he was shocked (but not surprised) by our collective response to the murder, why the cost of health insurance has gotten so out of control in this country, and what you can do about it.
The Cost of Health Insurance: How Did We Get Here?
Jean Chatzky: I know that there are probably 10,000 things that you can point to that are wrong with this system, a system that seems to consistently put shareholders’ needs ahead of patients’ needs, ahead of homeowners’ needs, but can you spell things out for us, what do you think is really happening and how did we get here?
Jay Feinman: We need to make the system of buying and selling insurance better. People generally don’t understand the details of what they’re buying. They focus too much on price and we need stronger regulation. It’s hard to understand insurance. People don’t want to think about bad things that are going to happen, and therefore, the insurance companies decided they’re going to try to sell on price and sometimes on service. But they’re not going to tell people exactly what kind of coverage they’re selling, and therefore [people are] going to be surprised sometimes when they have claims.
Jay Feinman: In the health insurance realm, the system is much more complicated because it’s not just the consumer and the insurance company. It’s the insurance company, the health care provider, the pharmacy benefit managers, and everybody else in the process. The Affordable Care Act made things better, but we still need to improve the way people buy insurance.
Why Health Insurance Forces Us to Focus on the Wrong Costs
Jean Chatzky: When we’re talking specifically about health insurance, people tend often to focus on the upfront cost rather than the overall cost. How would you encourage people to actually look at that purchase?
Jay Feinman: Health insurance is a little different than most because lots of people incur some health care costs every year. You go to a doctor for an annual checkup, you may be ill once or twice. Your homeowner’s insurance, if you’re lucky, you’ll never use it. You’ll never get your money back. But, as a general matter, people ought to think about insurance as protecting them against really large financial expenses.
Jay Feinman: If you go to healthcare.gov or the state marketplaces, the federal government now mandates relatively clear descriptions and relatively clear calculations of price for common conditions. For example, Peg is having a baby. And if you compare plans A, B, and C, this is what it will cost. Or Joe has type 2 diabetes, here’s what it will cost. So you can make a more rational decision, but a decision based on the potential large consequences, not relatively small costs.
Advocating For Yourself At The Doctor’s Office
Jean Chatzky: As a consumer, what am I supposed to do? What questions am I supposed to ask to protect myself going in as a buyer of medical services?
Jay Feinman: It’s very hard and one thing I tell people over and over again, either upfront or in the claims process, is often they think it’s their fault. They’ve done something wrong. The first thing you understand is it’s not your fault. You haven’t done anything wrong. This is the way the system is set up. So I encourage people to try to get information upfront.
Jay Feinman: [Say to your doctor] “I have gone to you because you’re in network or because my medical plan says this will be covered to a certain amount with a certain deductible or copay. Is that true of all of the services I will receive here? Is there anything else I might have to pay for?” Consumers should be a little patient, a little assertive, and very polite because the people they’re talking to are never the people in charge. Try to get that information upfront and ask the questions in a general way.
MORE ON HERMONEY:
- Why Don’t Women Who Need Life Insurance Have It?
- 3 Steps To Lower The Cost Of Your Homeowners Insurance Premiums Right Now
- Where to Turn if Your Insurance Doesn’t Cover Fertility Treatments
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