How Insurance Works (or Why Catholics Lie)

Read the full post here. (Emphasis in the quoted bits is mine) H/T Tally.

Insurance BASICS: Many people put money into a shared pool of funds to protect against potential loss. “Potential” being the key word, as you may never suffer a loss. You might not live long enough to collect Social Security, or be sick and need Medicare. You may never get into a car accident. Your house may never burn down, etc. You pay for insurance in case it does, and you do not get a refund if you never use it.

The money you pay into the pool is called a PREMIUM. If you do have a loss, the insurance company pays money out of that pool to cover that loss, which is called a CLAIM.

Everyone with me so far?

….

No matter what is offered by the plans, the employer doesn’t EVER directly pay for actual medical CARE given to a patient. That is done by the insurance company (who controls the pool of money that contains money from thousands of employers, not just one) – when they pay the CLAIM. The patient might be responsible for paying their deductible and copays depending on their plan, but the ONLY thing the employer directly pays for – if they pay anything at all, are PREMIUMS.

Under no circumstances do the employers have any say whatsoever on MEDICAL CARE PROTOCOLS, including drug formularies (list of medications that are covered by the insurance company.) For example, they cannot deny a patient chemo, transplants, or blood transfusions, or have any say on what specific medications your doctor prescribes for you. They cannot direct anyone’s doctor how to treat a patient.

….

Still with me? Then let’s start with the GOPChurches™ and not wanting to “pay” for birth control.

Seriously…go read the full post here.

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6 Responses

  1. So simple, and yet so lost among the hype and hysteria.

  2. Can I get Catholic Insurance to protect me against any harm to my physical or mental well being the Catholic Church may cause me?

    Or does that fall under “Act of God”?

  3. For example, they cannot deny a patient chemo, transplants, or blood transfusions, or have any say on what specific medications your doctor prescribes for you. They cannot direct anyone’s doctor how to treat a patient. re: the employer

    can the insurance company direct the doctor?

    • No, but there are questions about what constitutes “Accepted / acceptable” treatments and what may be regarded as “Experimental” or “Unproven” treatments.
      Insurance companies commonly look for ways to deny paying for things…which is not the same as directing courses of treatment (although it can, in some cases, amount to the same outcome).
      Some HMO’s will provide with a list of acceptable hospitals/physicians, which may not include the doctor you want to see or a facility that’s either convenient or your preference.
      There are other issues, all of them important…but not directly tired to the question of employers determining what will and will not be covered.
      This is why single-payer HC is necessary.

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