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Category: Health Insurance

28/05/2021

CTP Insurers Pay 6.3% of Premiums to Injured People. They keep the rest.

28 May 2021

This is a huge corporate scam. Why do people think that only little people are rip-off scammers? Also the idea that most people claims are ‘accepted’ is a nonsense. Insurers accept the claim, which means that they pay for a few GP visits and some physio. But they refuse to pay for scans that might find diagnoses. Then they refuse to pay for referrals to specialists who might need to operate. Then they refuse to pay for recommended operations. Then they use tame doctors (IMEs = Independent Medical Examiners) who either say that the condition does not need the treatment or that the problem was there before the accident so the insurer is not liable.

So the government introduced the PIC (Personal Injury Commission) to arbitrate all the claims that the insurers had refused. Now the waiting time for the PIC is over a year, which suits the insurers fine as the doctors and patients will use Medicare or private heath insurance to get the treatments and the insurers will either pay less or not have to pay at all.

If you thought the banks were bad, you have not dealt with insurers. NRMA refuses a considerably higher percentage of treatments than anyone else in my statistics, and SIRA declines to keep statistics on the ‘industry’ as a whole, and no insurer has ever been prosecuted for refusing a treatment.

This is why we need Medicare- a single, just, efficient, universal health insurance scheme.

www.youtube.com/watch?v=Sp8R856f7cM

11/12/2020

US Health System and COVID-19 11/12/20

Here is an article about the US Health system and its response to COVID. Basically it seems that the US government is subsidising COVID treatments so that they are more lucrative than treatment of other diseases, so the private operators are filling their hospitals with COVID patients whether they need to be admitted or not, and non-COVID patients are excluded.

The other thing that is interesting is that there has been a huge growth in administrators since the 1970s. It has to be understood why private health systems are so inefficient. They have to keep individual insurance databases to keep track of premiums and churn as people change funds. When someone is treated they have to account for every band aid, visit, procedure or investigation, bill the patient and pay the practitioner. They have to market their product, compete for staff, and then figure out ways to avoid paying if possible.

Universal systems have everyone eligible, so do not need to worry about who is getting treated. No need to market the system, maintain many different churning databases, compete for doctors, keep accounts for every details of every treatment and bill and pay for them individually.

In terms of better health care there is no problem of adapting to whatever disease needs the most attention as the staff are motivated to do the most effective treatments, and there is no distortion of priorities to maximise profits.

The US health system is the least effective in the developed world in terms of delivering health care. but it is the most effective at its primary object- turning sickness into money.

No one has looked too closely at why the Australian system has been able to respond. Basically our public health system is State-based hospitals, which are still largely public and have doctors who could be re-directed to testing and vaccination. They can also change to do COVID if needed, and treat disease on their merit.

The private hospitals did very well out of the government subsidies here because they were emptied ready for a COVID influx that never came and they just pocketed the cash without much publicity for this from either themselves or the Government.

Australia has continued on its previous course, which is to starve Medicare and help the private system move towards a US system by stealth, and the COVID pandemic has so far not brought this to light. What is left of the public system has done well, helped by the fact that we are an island nation, so had some warning and could act to quarantine ourselves. The government was happy to take advice from the medical professionals because it had made such a mess of not taking advice from the firefighting professionals. But Medicare is still being quietly destroyed and we are moving to a US system of private medicine.

The government saves money on Medicare doing this, even though the system is much less efficient and much less equitable. But the key reason is not the savings on Medicare, it is the money to the Party coffers from the Private Health Industry (PHI), which is now much stronger with the changes John Howard did to the Aged Care system in 1997, which made it effectively a for-profit system, and the NDIS also a for-profit system, subsidised by the taxpayer through the Medicare levee, which was ironically not being used for health. (The discussion of the Aged Care system was in one of my posts last week).

The key thing to understand in the destruction of Medicare is that the rebate to doctors which was set at 85% of the AMA fee, so as to replace private medicine, has risen at half the inflation rate for 35 years and is now 46% of the AMA rate. Doctors are paid half what they were, so specialists mostly will not use it, and GPs who still bulk bill just do shorter visits.

Here is the article on the US response to COVID. Their prevention is also hopeless, as with such a poor welfare system the people cannot afford to stop work, and the story that it was a hoax was also promoted by President Trump. The obsession with ‘individual rights’ sits uneasily with the idea of staying home for the common good, and makes disinformation campaigns easier. People wanted to believe it was a hoax, because they could not afford to stop work anyway.

http://www.informationclearinghouse.info/55999.htm

11/09/2016

CTP Facebook Article- The Facts 11/9/16

CTP, Compulsory Third Party insurance (Green Slips) is an area where I work. In theory, if you are injured in an accident that is not your fault, all your treatment is currently paid for by your insurer. The law says that they must pay for ‘reasonable and necessary’ treatment, which I assume to mean the treatment that would happen in good routine medical practice. Wrong.

The insurers have 3 months to decide if they are liable for the accident. If they decide they are not they will not pay. If they decide that they will pay, all treatment decisions have to be referred to them as to whether they will pay or not, and sometimes, despite MRI scans, severe symptoms and a neurosurgeon saying that their life is at risk, they will not pay. I have a number of patients who have waited over a year in agony for treatments that are both reasonable and necessary but the insurers will not pay for. They say that the patients can get it themselves if they like (obviously if they can afford it), of they can get it on Medicare (if they have Medicare and if they can find a surgeon who will operate on Medicare for a third of the money that should be paid by the insurer. Such surgeons cannot be found).

The protocol for disputes vary slightly between insurers. For example, the NRMA protocol is that you can firstly approach the claims clerk who rejected it and ask him/her to change their mind. Secondly you can appeal to their team leader. Thirdly you can appeal to the NRMA Senior Claims Manager. Fourthly you can appeal to the government appointed Medical Assessment Service (MAS), which guarantees to assess the disputed issue and rule within 3 months! Or the treating doctor can try to find a Medicare surgeon, send them to a public hospital, or write yet another prescription for pain killers. (Mostly the insurers pay for pain killers, though they do argue over some other drugs). Many GPs have simply given up treating CTP patients.

All these delays, frequently running into months can be compared to the doctors and nurses in Emergency Departments of public hospitals who have to write long explanations for the Health Minister if patients wait more than 4 hours in the Emergency Departments. So if you think private medicine is better than public- think again. We are going the way of the US. Insurers control it all.

Patients are assesses by an iniquitous system devised by American Insurance companies in cooperation, (inexplicably enough) with the American Medical Association. This has resulted in a tome, the ‘AMA Guidelines for the Assessment of Permanent Impairment’ which supposedly gives a percentage of impairment of your body, so that injured people can get compensation based on the percentage impairment that they have. Doctors can do a course in how to use this guidebook and then do lucrative medicals based on it. The reason the book was produced was to lessen litigation on how injured someone was, which would save legal costs. As pain cannot be measured, this was left out, which is just the first reason why the book is a farce. Since pain is the main thing that stops people working, to talk of impairment without considering pain is almost like having a swimming race without water- just not quite. Secondly despite the tome’s carefully crafted descriptions, doctors assessment using the guidelines vary widely. Thirdly, it is very hard to get over 10% impairment, which is the amount Mr Baird’s reforms intend to define as more than a ‘minor injury’ so there will be many people with only a few percent impairment, and thus minimal compensation, who will be unemployed and unemployable. Fourthly, the guides only talk of ‘impairment’. Any one who works in disability knows that there is quite a difference between an impairment and a disability. For example if someone is very shortsighted they are impaired, but if they have good prescription glasses they may not be disabled by that impairment. People who work with their brains are similarly less disabled than those who need their physical strength, but have the same impairment. So physical workers are again disadvantaged.
The new scheme will cut out lawyers and advocacy, and will give a statutory small amount to ‘minor’ injuries. The insurers will dump long term patients on the welfare system and continue to get a lot of money for doing not much that is useful.

I would finish by saying that I think the whole system is appalling and that the way to solve the health system problem is to raise the Medicare rebate from 48% of the AMA fee to 85%, where it was when it started, and there would be no trouble getting doctors to treat the patients who needed it. There also needs to be a single insurer, so that disputes between insurers will not delay treatment, which they frequently do, and everyone should be covered, even ‘at fault’ drivers, who still need treating despite their error.

For the present six insurers, all are bad, but they are not all as bad as each other. There are no published figures to compare them rationally, but based on personal experience, I have just changed my insurance from NRMA to GIO. The TV ad about feeling ‘confident’ about your insurer is a bad joke.
Wish me luck, as I wish you.
Here is an SMH article by Anna Patty 12/9/16 which raises the issues in a somewhat understated way.

www.smh.com.au/business/workplace/green-slip-reforms-will-leave-most-motorists-to-fend-for-themselves-20160905-gr8zca.html

21/06/2016

Medicare- Did the Liberals try to abolish it?

21 June 2016 This is a current question with Shorten claiming that the Liberals are trying to privatise it and Turnbull calling this a Labor lie. What is the truth? The answer is in the history of Medicare funding. Medibank was set up by the Whitlam government and the bulk billing frees were set at […]