Health Insurance, Dental Up-Sell, Synergy, Las Vegas and Anal Lube

I was paying, at my previous job, 10% of my salary for insurance that didn’t include dental.  Including dental, in the next enrollment period, upped the bite to just under 12%.  As it turns out, I was paying that 12% of my income so that at the end of the day, after deductibles and co pays, I could have the right to pay twice the going rate for dental services.  Services that I could only receive from a single supplier and that were provided by dentists who were unable, unwilling or deemed unfit to have their own practice, and whose primary directive seemed, at least on the surface, to be up-sell the shit out of the bleaching.

I was glad I had a job and equally glad that job came with a medical plan.  I was trained to be glad about such a thing.  I believed that I was “covered”. I believed that coverage for me and my family was a good thing, the best thing, perhaps the only thing.  The coverage would save me money and “insure” that if something went wrong, medical treatment would happen.  I wasn’t glad about the 12% of my pay for a minimal plan to cover my wife and 3 kids and I’m really not glad about the fact that we still had massive deductibles and yearly out of pocket benchmarks for each person in the family or that prescriptions were mostly only covered if they were generic. And I was really not glad about the fact that if one looked just a little closer at the whole setup, that it was in fact, a setup.  I was being played like a Stradivarius by Jascha Heifetz himself.

This system, this set up, this percentage of coverage/co-pay/deductible scam runs so deeply into the system that nobody even blinks at it.  Most folks who have insurance accept on the face of it that they pay a lot of money and don’t get much in the way of coverage.  Some have even done the math to figure out that 12% of their pay, if banked instead of paid into insurance, could be a big fucking bag of money with which to pay your own medical bills when they come along and that the only thing one really needs coverage for is the catastrophic stuff, like cancer.  But you can’t get just cancer insurance because not enough people get cancer to scare us all into buying the insurance.  (yes a lot of people get cancer, but as a percentage of the population, the numbers are actually pretty small.)  Insurance companies make money by selling insurance, not by paying claims.  So if they really want to make money they have to sell insurance that doesn’t cover the stuff we could all cover by ourselves (but appears to when you’re buying it) and only really has to pay out when the dice come up craps and you have tumors taking over your liver.

Insurance has been likened to a bet.  It’s gambling, or so this analogy goes, like putting a stack of chips on 18 red in Vegas.  But I promise you that if you placed that bet in Vegas and the Casino decided to only pay off part of the bet (and only when you could prove that you’d actually won the bet during a time when you were allowed to win the bet and then only after you badgered the lady at the cash window 4 times, her supervisor twice and finally an account manager with the casino who was finally willing to give you about 40% of what you won because they had a lot of costs associated with taking your bet and dealing with you since you won your bet and the cost of advertising casinos in general had gone up and one of their sister casinos in New Orleans got destroyed in Katrina) I fucking bet you that if they did that, they’d be out of business, in jail and the subject of a class action lawsuit so enormous that it would make the Gulf Oil spill look like a kitchen mess at my mom’s house.

But we just accept it.  It just is.  It just happens. it’s just the way it is.  And don’t think that the new stuff coming out of Washington is going to make a lot of difference anytime soon.  The only guy in that whole mess who doesn’t owe a dime to the insurance industry or the medical industry or the pharmaceutical industry is the one guy who can’t do anything about it because he’s only the president and he can only sign or veto, he can’t write the law.  All the other players with skin in that game have dirty noses and greasy palms.  It might end up sounding like something is getting done and it will look on the surface like a thing or two are different, but this is about money, and cousin, you ain’t got enough to make a difference in this fight.

While I was employed, we had medical coverage and then on top of that, we had to add dental coverage because somehow that’s not the same damn thing.  If I get hit in the face by a speeding truck, the work they do on my mouth will be medical.  If I get a cavity in a tooth or need a crown or a root canal, that’s dental no matter how much surgery is involved.  What an enormous bunch of horse shit.  Dental is medical.  Medical, dental, optical, psychiatric; It’s all me.  It’s all body parts, wellness… health.  We don’t have a separate kind of insurance for my feet or my rectum.  There isn’t a split in coverage for spinal.  I don’t have to have separate coverage for the seats in my car and the radiator.  Why in the name of all that is reasonable, do I need separate insurance policies for my mouth and my body?

So we had dental coverage on top of the regular medical but with twist that made me wonder if it’s even legal.  It could be illegal but how would you know?  Hell, you’d need a team of antitrust lawyers and 5 years to sort it out and who the fuck has that?  What appears to normal people to be a serious conflict of interests and a breach of moral conduct, is, in the business world, called synergy.  Man do I hate that word.  I used to think synergy was a great idea. At least, I’d been taught that it was a good thing.  It was a thought that when first thunk, probably sounded great.  I bet it sounded, to the guy who first pictured it, almost as good as communism sounded to Lenin.  On paper it was brilliant and for about 3 minutes it was a perfect idea.  Then people got involved.  And that, as they say, was all she wrote.

Synergy is when companies work together; usually when they are owned by the same parent company.  Company A makes tires and Company B makes cars and Company C does auto loans.  If one company owns all of those companies and they work together, they can save cost, lower their prices to the consumer, increase profits and everybody wins.  Cue the band, start the ticker tape and get the band marching down the street.  This is gonna be great.

The company I worked for was small and to save money we farmed HR functions out to a company named ADP. We replaced valued employees with an outsource mega-company providing a reduction in actual services and whose customer service is in several other countries.  Many of you will recognize the initials ADP as they probably appear on your pay stubs.  ADP is a giant in the payroll industry  that is owned by a larger company and that larger company owns many companies.  ADP, as a part of their “expanded service” product pack also handled health insurance, dental insurance and 401Ks.  One of the companies owned by that larger company is Monarch Dental.  See where I’m going with this?

I want to talk for a moment about synergy but I’m not sure how to start so let’s for a brief bit imagine I’m an enormous corporation.  Envision me as a single person but really, I’m a group of people (boards of directors) following the dictates of a smaller group (majority stockholders) under the supervision of a single person (the CEO).  Let’s say that I own a big list of companies.  One of them does medical insurance.  All of my companies have employees and they all need insurance.  All of the employees in all of my companies take a percentage of their pay and put it into medical insurance using the company or companies that I’ve chosen.  For dental services, I chose the company I own because I can make more money that way and, you know what, fuck them if they don’t want it.  The insurance company I own has a captive market of employees who, if they want to have medical/dental coverage through their employer (me) must get that coverage from my company.  My insurance company creates the packages to create the appearance of choice (because people want to have choice, even if 98% of them chose the same thing), sets the coverage levels (which, after co-pays, deductibles and annual out-of-pocket thresholds is really not much in the way of coverage), and sets the rates so that customers (captive employee-fish in a very densely packed market barrel) “choose” the coverage that I want them to chose so that 12% of all the money I pay my employees to make money for me actually comes back to me so that I can use it to make more money for me.  The dental coverage of my insurance company only covers the services provided by my dental services company.  Now my dental services company has a captive market, too.  Isn’t that great!

And this is only a small set of the companies I own that provide services my employees believe they need and that I am required by law to provide to them.  My employees think this is a benefit… a good thing. I also own investment houses (401Ks), Banks (home and car loans), and credit card companies (credit card companies). It’s a closed loop system for me to take money back from my employees.  They used to call it a company store in the old days where the coal mine owners also owned the stores and the houses and everything else in the company town.  Everybody who worked at the mine also rented the houses and bought the food and clothing, and the prices were always high enough to leave almost nothing left over with which the employee might decide to move somewhere else.

That was a synergy in its infancy.  It could barely walk then.  Now, it’s big, strong, healthy and running at top speed.

The new Synergy is the standard model nearly everywhere.  Intellectually it makes sense for companies to share resources and reduce redundancies.  It has the obvious potential to reduce cost to the consumer and thus make the companies (and by extension the products they offer) more competitive.  That’d be great if that was what happens, but the end result actually is that we still make the same amount, we still pay the same amount, we still get the same result and the savings, if there are any, go to the company (read: stock holders).  It sucks but it isn’t illegal (as far as I know since I’m not an antitrust lawyer) and my single voice would never be able to stop it anyway.  Besides, the stock holders didn’t invent the system.  They’re just using it to make money, like anybody else probably would if they only could (because if given the opportunity to make a bazillion dollars we are all heartless, greedy cold-ass motherfuckers and we would take the money). But for the record, this end of the proposition sucks.

So,.. Dental plan. Remember the dental plan?  That’s what I was writing to tell you about. I need a bunch of work done on my teeth.  I need two inlays, two fillings and a crown.  That is it. That’s what I need.  The estimate presented by Monarch Dental shows a bottom line of $14,000.  The insurance would cover $8 grand and I would be required to come up with $6K.  Please pay in advance.

I went online and started comparing prices where I could find them.  I compared apples to apples and I totaled up the cost.  $3,800 all in.  Same stuff, same procedures, same number of trips, vastly different price.  If my insurance allowed me to shop around I could save a lot of money.  But my Insurance doesn’t allow me to shop around.  I am only allowed to use Monarch Dental.  That’s the plan I chose.

I had the choice of two plans.  Plan A) See any dentist you want.  It costs you twice as much and we’ll give you half the coverage and double the deductible.  Plan B) you go to our in-house dental company where we can control the costs by having dentists from the Costa Rican School of Dentistry and Cosmetology.  Your premiums, though actually pretty high, look low compared to Plan A, and your deductible compares favorably for the same reason.  So choose this one and we’ll reserve a greased-up stick for you.

I was, you were, we all were, maneuvered into buying the plans we’re on.  The companies don’t matter.  The plans are nearly identical and the percentages of people who choose one over the other are the same for every provider. As it turns out, when I finally needed to use the plan, the cost of services had been marked up so much so that I would end up paying, after the insurance had done all that they would do and paid all that they would pay, twice as much as it would cost me at some other dentist and without insurance coverage. This was the plan that I was trained to believe was a good thing for me and my family even as me and all the other geese were being force fed a steady diet of lies and scare tactics and readied for the fois gras man to come and harvest us.

As I’m reading this, I’m still not saying what I intended to say.  Here it is.  The insurance isn’t intended to cover me or my family for anything.  It is intended to remove money from my paycheck. It is a system whose sole purpose is to make money in enormous boatloads.  It is not, nor has it ever been, a device for ensuring anything other than that you will pay a monthly percentage of your income into a corporate black hole.
 
So, don’t take it anymore.  Don’t just say, whatever, what can I do.  Make a stink.  Every time you have to deal with them either on the phone or at the doctor’s office or through your HR department, make a stink.  Every time you talk about it with friends or in public or when you’re talking to a person with influence, make a stink.  Call radio stations.  Write letters to editors.
 
Or better yet… stop paying them.  Stop buying in.  Stop playing a game in a casino with no rules other than that you can’t win.  Take that 12% of your monthly income and bank it.  Put it away.  Call the fund “Just in case” because by now, the name insurance is carrying a lot of baggage and something in those bags smells rotten.

Advertisements
This entry was posted in Uncategorized and tagged , , , , , , , , , , , , , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s