Insurance Companies

"The principles of Jefferson are the axiom of a free society"

Abraham Lincoln


A Nonpartisan Economic, Health and Public Policy Research Foundation

INSURANCE CARRIER ADVANTAGES

1) MAJOR COST SAVINGS TO INSURANCE COMPANIES

a. Significant expansion of markets due to ALL Americans purchasing:

i. Health insurance

ii. Long-term Care Insurance

iii. Disability Insurance

b. Separation of Financing from the Delivery of health care at the Provider Level will eliminate the perverse incentives associated with the current third party payer procedure-driven system

c. This plan eliminates the multiplicity of health plan claim requirements and the bureaucracy necessary to pay those claims giving us a “single payment” insurance plan

d. This design reduces costs and prices by eliminating twenty-two of the twenty-three cost drivers responsible for inflating insurance premium prices

e. Insurance company will only be responsible for non-discretionary spending associated with the insurable event. This will be completed by a single “Lump Sum Transaction

f. Insurance company will make a “Single Lump-Sum Payment” to the patient to allow for payment of non-discretionary care associated with the insurable event. This will eliminate multiple insurance payments for multiple procedures currently at the discretion of the patient

g. Eliminates all the perverse incentives associated with the current third party payment procedure driven health care, which results in patient over consumption and provider over-utilization.

h. Eliminates the perverse incentive for physicians to inappropriately utilize expensive, high-tech procedures.

i. Protocol utilization will eliminate the perverse incentive of physician to defensively order unnecessary testing for protection from potential litigation.

j. Abolish State Mandated Insurance Benefits by obviating problems derived from third party payments that MIB are designed to eliminate.

k. Protocol Paradigm will Reduce Administrative Costs

i. Reduced staffing currently associated with provider micromanagement.

ii. Eliminate complicated & expensive legal contracts that were formally associated with lump sum payment and writing policies in the individual market.

iii. Design High Risk Pools for patients with pre-existing and/or chronic conditions. This will be accomplished via public and private subsidy which will establish a more equitably system allowing insurance companies to more effectively spread and manage risk.

iv. Improvement of profit margin will occur due to significant reduction in overhead, rather than by third party rationing to patients and price controlled under-market-value payments to providers.

v. Elimination of “Moral Hazard” Issues

vi. Elimination of “Adverse Selection” Issues

vii. Appropriate Lump-Sum Payment will allow the patient to pay for all non-descretionary care only. This will eliminate insurance payments now being made for procedures associated with discretionary care.

viii. Elimination of Insurance payments for 90% of Family Doctor visits because these encounters are for conditions that usually self-limiting and rarely require procedural care.

ix. Elimination of cost associated with both eligibility and denial of claims (both in paper work and time).

x. Plan is a 24 hour product and thus will eliminate the expense of determining eligibility between Employer Based Insurance and Workman’s Compensation Insurance.

xi. Discourages filing of fraudulent claims

xii. Discourages filing of claims for non-insurable events such as “back pain” not otherwise specified.

xiii. Eliminate the need for “Guaranteed Issue” as the only strategy to achieve universal access.

xiv. Eliminates the use of “Community Rating” with its self defeating aspects as the way to manage risk

xv. Introduces innovative risk sharing and spreading tactics

viii. Elimination of Insurance payments for 90% of Family Doctor visits because these encounters are for conditions that usually self-limiting and rarely require procedural care.

ix. Elimination of cost associated with both eligibility and denial of claims (both in paper work and time).

x. Plan is a 24 hour product and thus will eliminate the expense of determining eligibility between Employer Based Insurance and Workman’s Compensation Insurance.

xi. Discourages filing of fraudulent claims

xii. Discourages filing of claims for non-insurable events such as “back pain” not otherwise specified.

xiii. Eliminate the need for “Guaranteed Issue” as the only strategy to achieve universal access.

xiv. Eliminates the use of “Community Rating” with its self defeating aspects as the way to manage risk

xv. Introduces innovative risk sharing and spreading tactics