DO YOU KNOW HOW INSURANCE COMPANIES WORK?

Your Insurance Company is a business. Your Insurance Company is like any other company in business, as they are in the business to make money or make a profit. So the question then becomes,

How Do They Make A Profit?

First we need to understand how the Insurance Company makes money. They sell their product, in this case health insurance, with the hope that they will sell lots of policies and collect lots of premiums and pray that not every policy they sell will be used by their subscriber. They are banking on this fact alone. Then they will have profit. 



How do they maximize their profits? 

The problem in the insurance industry is, can they sell more policies and collect all their premiums, while doing whatever they can to deny or delay payment of claims. This way they keep more money than they pay out and they become more profitable.

As an example, if they take in $100,000 in premiums and paid out $100,000 in claims, would they stay in business? Obviously not.

So their job is to figure out a way to continue collecting premiums, while not letting the money go toward paying claims; and they do this by either denying the claims or delaying payment of the claims. The delaying or denying of claims allows them to now draw interest on all the money they collect in premiums. They use this to pay their share holders and pay their executives.

Is it fair for your Insurance Company to not pay your claim related to your health concern? 

NO.

And it has it become the standard in the industry to find ways to cut claims and not pay for everything or to find reasons to not pay any of the claims at all. In other words, they look for reasons to reject the claim.

How can they do this?

They have found a way to do this by hiring doctors who determine what gets paid and what does not. They sit in an office and they do what is called "Review Paper Claims." They will call or mail your doctor and ask your doctor to provide them with all of your information about the claim. This gives them a reason to delay paying the claim, as it is "under review" and ultimately deny paying the claim. They may even go as far as sending you a letter stating they have "asked your doctor for further information about your claim" before they can determine if the claim is valid. They make it seem like your doctor is not doing their job when the information is incomplete or not to their standards or not filed in a timely manner.

At this point the question needs to be asked: who does this doctor reviewing your claim work for: You or Your Insurance Company? 

Obviously the Insurance Company. 

And since they work for the Insurance Company, whose interest best gets served, you or their employer, the Insurance Company? 

Now if the doctor approves too many claims for payment, would they not have a job for very long? Not if the Insurance Company cannot pay all the claims and maintain a profit. 

So is it in the best interest of the Doctor and the Insurance Company to reject your claims? Of course it is. 

So the question you need to ask yourself is, "If a doctor I never actually see, doesn't do any treatment on me or sees my file, do I think it is fair that they determine what care I need or are entitled to and what care is in my best interest?" 

I think you know the answer to that. 

So, this creates a decision for my office which is controlled by you. 

I can work in conjunction with your Insurance Company based on their profit margin and paying their investors and who will never actually see you and I can do what they say and is in their best interest,

         OR

I can work for you and give you what is in your best interest based on what you and I feel you need.

Which do you prefer?

I want to do what is best for you and what will allow for you to be as healthy as possible. After all, this is my purpose and why you will hire me. AND I can only do what you think is best and what you choose. So even though I am trained to help you resolve your health concerns, I can only help you if you agree to allow me to help you. 

So the question you need to consider is,

Would you like me to work for you and your best interest?

OR

Would you like me to work for your Insurance Company and their best interest? 

And if I put your care in the hands of your Insurance Company, Do you really think you will ever get well?

Medicines Two Choices for You

Do You Have Health Insurance or Sickness Insurance?

Many times a prospective patient will call the office and ultimately ask, "Do you accept my insurance?" As a member of my practice base, or perhaps soon to be a member, you'll know the answer is "No, I am not an insurance based practice." And the reasons for that are numerous including what I will be discussing here momentarily. AND the title of this article is the important question for you to consider before looking to use your insurance. The understanding of which will allow you to make better decisions about your health and the type of insurance policy you choose. I also hope to give you some questions to ask your current carrier or your prospective new carrier, and certainly your HR person at your place of employment.

Health Insurance vs. Sickness Insurance

I differentiate the two because there is a significant difference in each.

Health Insurance, as many people incorrectly think, is designed to help you maintain your health when you have a health concern. This is far from accurate. Most Insurance Companies hide behind a "benefit" that is nearly impossible to take advantage of. And if the subscriber does get coverage, it is never as good as you believe it to be.

Most consumers believe that by having "health insurance," they can go to a doctor or hospital and get whatever care is required to get them back to their pre-condition status. Unfortunately, this is anything but the truth. The true benefit of your health insurance policy is to bring you back to being "sickness free" or "symptom free" and even that isn't always honored. 

Sickness Insurance is what most people have, which is insurance designed to be used if you are sick or have some sort of symptom of disease. And the coverage for the "sickness insurance" is designed to get you out of crisis and for the most part, that is about it. It is not designed to get you to an ideal level of health. In fact, it is not health insurance at all, as it is not designed to allow you to be healthy. Therefore it should not be called "health insurance."

Symptom Care Policy

What you need to consider is, in order for your insurance policy to kick in, you have to have a symptom of a problem. Appreciate that in order to have a symptom, you have to have already lost 60 % OR Greater of your normal function and be at 40 % function or less. What this means is to experience a symptom, the part of the body that has the pain or discomfort is really only functioning at forty percent of its capacity, at best.

And your insurance will pay for you to get to forty-one percent or perhaps as high as forty-five percent. NO MORE!

AND, it will never pay for you to be 100 %.

Therefore, you get to ask yourself a very important question related to your health:

"Do I deserve to simply be symptom free and function at about 40 to 45 % of my capacity, or do I deserve better?"

And if you feel you deserve better than 40 to 45 % of what you are capable of, what are you willing to do in order to get it? 

Responsibility is a tough thing for some. And yet we all have to take control of our lives. And believe it or not, it starts with your health. When your health is good, not just symptom free, you enjoy your life.

If something comes up that is not to your liking, you can usually overcome it without much difficulty, as everything is working well.

When you are not well and your health is letting you know with different symptoms, your days and your life are anything but fun.

And if you are confronting that right now, it all comes back to ownership. Being responsible for your health and the functioning of your body will require you to get back to taking ownership of your body. 

Taking ownership of your body means to do several of the following: Eat healthy foods, drink plenty of natural spring water throughout your day, avoid caffeine and high fructose corn syrup drinks, exercise several times a week, get proper amounts of sleep, breathe properly to keep everything moving.

Also develop a mindset that keeps your health in focus.

Equally important is for you to have someone who can help you monitor your health levels so you can maintain the highest level of functioning possible. We're talking about being closer to 100 % of your capacity compared to the 40 to 45 % your insurance company will allow you to be.

So the next circumstance to face is 

how do I get my insurance policy to pay for my health?

If you've been paying attention, your insurance policy will not pay for your health and will not pay for you to be healthy.

Your Solution

This means you have two options: 

1) You can begin to develop a plan to help improve your current level of health and function and continue to focus your attention their regularly through developing habits and routines to support your health. 

2) You can figure out a way to live with increases in health issues as you go forward with your life. After all, if you are hovering around 40 to 45 % of your capabilities, it is only a matter of time before your functioning will dip below the magic 40 % threshold. And at that point you will be able to use the insurance you pay for to allow you to get back to above 40 %.

Which do you choose?

If you'd like some help developing a health plan for yourself, you have several options available to you: 

1) You can click on the New Patient Coupon and receive a discount on your Initial Consultation and Examination to see if the techniques I use can help you regain your health 

2) You can buy my new book called " When Your Health Matters: Using Your Body's Natural Rhythms To Restore Your Health."   This 252 page volume is 12 months worth of healthful and helpful information designed to help restore and maintain your health one organ or gland at a time depending on the month we are in and the season we are moving through. It is available for purchase through the office. Simply call 845-561-BACK or 561-2225 for information.

3) You can come to a FREE Health Care Class every Tuesday evening to get some hands on experience with me as I discuss all the topics contained in the book and help to evaluate the participants each class. There are 50 classes total throughout the year and are given every Tuesday evening at 6:30 pm at the Pooler, GA Office. Simply call 845-561-BACK or 561-2225 for reservations. Since class size is limited, we do ask you to make reservations as my personal guest.

4) You could tune into my New York based radio shows heard on Saturday Morning Radio Show that airs on 1260 AM or 1420 AM beginning at 9:00 am, or on Sunday mornings airing on WRWD 107.3 beginning at 6:30 am.

You could also tune into my Savannah, Georgia based show heard Saturday evening at 9:00 pm that airs on WTKS 97.7 FM and 1290 AM.

Each week I discuss the same information I do in my book, in my Tuesday evening FREE Health Care Class and in my new book, " When Your Health Matters: Using Your Body's Natural Rhythms To Restore Your Health." 

Don't have time during those show times, you could simply go to www.TheAlternativeHealthcareNetwork.com and click on podcasts to listen to the current or any past shows since August of 2010.

5) You could e-mail me directly. Simply click on the "e-mail us" at the bottom of this page or click on "Send us an e-mail" at the top of the page. 

I usually answer all e-mail before 7 am or after 7 pm when I am home from work. Many people who are from all over the country e-mail me and may never actually come to see me, and that is O.K. 

Finally, you could simply call me directly at (845)561-BACK or (845) 561-2225 and we can talk about any of your health issues and what you can do to help yourself.

Regardless of which way you choose, please take the time to understand what your insurance policy does or does not do for you and then take the time to develop a plan. Consider consulting with me for your health care needs and never have to deal with activating your "sickness policy."

I look forward to helping you.