Health Insurance Companies. must create uninsured and catastrophic coverage

Pools will cover catastrophic care for all and provide for the poor

Catastrophic insurance coverage will be separately delineated as a portion of the premium. Some will be set aside for a national catastrophic pool. Based on a proportion to be shared with the government and other voluntary supporters, this pool will pay for all catastrophic care. Insurance companies will pay 100 percent of all care of their insureds that fits a government-defined definition of urgent care with no co-pays.

Insurance costs for non-urgent care will have 1 to 25 percent co-pays on all bills. Whatever co-pay that the patient selects in their insurance plan, the hospital charges will be half or one-quarter of the selected co-pay. As people attempt to decrease their small portion of their own bills, they will automatically decrease the insurance company’s larger portion of the bills. Fees will drop substantially within the first several years of the institution of a free market for finding health care.

Insurance companies will only have to sell policies on the basis of two criteria: the percent of co-pay the patient chooses and the threshold amount for non-urgent services that require a 2nd opinion. All other issues that obstruct care will disappear: networks, providers, deductibles, provider negotiated fees, mandatory IME’s, need for referrals, need for authorization, etc. Finally, patients will be able to compare and shop insurance as they would any other commodity.

Other tenants of the plan include:

  • Deductibles are to be historic. No more deductibles because they cloud issues and prevent patients from understanding true costs.
  • Medical savings insurance plans are critical to the success of the plan and must be cheaper with more incentives to save.
  • No exclusions for preexisting conditions ever.
  • All plans must be portable state to state and regulated at the federal level. Any state licensed provider can see any patient.
  • Simplify plans that are easy for patients to understand
  • Track, identify, and provide information for prosecution of medical/legal insurance fraud by doctor, patient, carrier, or attorney.