- Posted by Austin Swim
- On January 30, 2015
- 0 Comments
- industry news, insurance industry
Insurance Companies Must Make Profit
The insurance industry, like any other, is a business first and foremost. They exist to make money. People that understand this know it’s a necessary part of our infrastructure as a society. The fact remains that if health insurance wasn’t a profitable business, it wouldn’t exist at all and then people in need of help would continue suffering.
So, how do insurance companies cut costs to ensure the majority of people get the care they need? It’s a one word answer, denials.
Though the billion dollar question for industry experts is, “How much must We(the health insurance company) pay out to the individuals contributing to the money pool at any given time?” Depending on one’s point of view, the health insurance system could be considered an efficient yet imperfect machine or an entity that falls short when needed most.
Insurers Say Try Cheapest Option First
Health insurance, of any form, is expensive. It’s all too common that we see premiums go through the roof. The financial difference between inpatient and outpatient care is astronomical. Often times, insurance companies believe that the cheapest option for care is substantial, and therefore the most beneficial for the customer because of the lower out of pocket cost.
“Although outpatient treatment can be substantial for some, this is not typically the case,” comments Peter Busch, behavioral health counselor. “Inpatient care, although expensive, is highly recommended for most dealing with addiction and mental health issues. Those that complete the entire program experience much higher success rates, and require less future treatment.”
It appears what is happening is that insurance companies have the opposite outlook on treatment than authorities in the behavioral health field do. This is where the system begins to fail people for people who need it.
When the System Breaks
Heroin Addicts Forced into Lesser Care
Insurance companies routinely force people facing a drug addiction into outpatient treatment before they approve them for inpatient treatment. Immediately, it’s easy to see how this is a can be controversial. In the eyes of a drug addict, the insurance company wants them to fail before they can begin to get the treatment they truly need to succeed.
Take heroin abusers for example; ultimately 9 out of 10 people in recovery will relapse. This is considered an understood part of the process. This means that although someone attends inpatient treatment, it doesn’t automatically add up to success. So what’s the big deal? Why can’t people just go through the normal channels and seek out outpatient first? Well, for many individuals waiting gives them an excuse to only masking the true problem which can lead to other dire consequences.
Masking One Addiction with Another
Methadone is a drug used for those addicted to replace the heroin fix. Unfortunately, Methadone is also a highly convenient solution for someone looking to hide a larger, long-term problem instead of solving it. To continue with our heroin example, it’s likely people forced into outpatient care will come to the same conclusion: “I can replace my heroin use with methadone pills, I’m not using.” It’s cheaper than inpatient treatment up front, but it’s a controlled high that people can still become addicted to, and use for a long time to come.
In an eye witness interview with Elements Behavioral Health a long time methadone user was interviewed, he said that he had been taking methadone for 14 years but that he would be dead without it. This one is just one story out of an entire displaced group, that isn’t getting the initial coverage they need.
So, in the interim we have to sit idle and wait for the system to change for the better. Despite the drawbacks for individuals, we understand how we got here in the first place. That said, the bureaucracy of the health insurance system may be negatively affecting individuals more than insurance companies initially imagined.