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Re: [IP] What I found out when I called GHP CareMark insurance about my Humal...

In a message dated 9/15/01 11:16:12 PM US Eastern Standard Time, 
email @ redacted writes:

<< I did call the insurance company - and apparently each company that has 
 insurance has their own policy.  No two are the same.  >>

I guess it always surprises me that people don't know this. The insurance 
company sells a product. That product is made up of many pieces that each 
have a cost. Your employer chooses the pieces that it needs at a price it can 

You could compare it to buying car insurance. (Something everybody is 
familiar with.) State Farm does not have a standard policy for everybody. 
Nationwide does not have a standard policy for everybody. Etc. You don't buy 
State Farm if you want "this" in your policy and Nationwide if you want 
"that" in your policy. You choose what you have to have, what you need and 
what you want, shuffle around with deductibles, etc., and you shop around to 
get the best price from among the reputable companies. My husband and I, for 
example, use the same insurance agency and agent, but our policies are not 
the same because our cars are not the same age. Neither of us are 
accident-prone, but if one of us were that would make a difference in what we 
pay, too. 

So it's the same with health insurance. If you were buying health insurance 
in the private sector (if you could with diabetes :-\ ), you would decide 
what kind of coverage you need, how much of a deductible you can handle, 
whether you need prescription medication coverage, maternity coverage, etc. 
Then you would probably take that list and shop around the different 
insurance companies that provide coverage in your area to get what you want 
at the lowest cost. That's what your employer does, too. 

However, your employer is doing it for the entire workforce. Just like you, 
your employer only has so much money to spend on insurance. So they get the 
best deal they can at the best price they can. What they get for the benefit 
of the whole, however, may not benefit *you* in particular. Them's the 
breaks. :-\ So if you're dissatisfied with your insurance coverage, the place 
you need to "lobby" is your employer.

For example, the place that covers me (through my husband) did not cover 
diabetes education. So I called staff benefits and explained the importance 
of being educated about diabetes. (The fact that my coverage is through a 
university -- which *sells* education, and I pointed that out -- didn't hurt. 
LOL) It then began covering diabetes education. (This was before state law 
was passed mandating diabetes education.)

Now. To make things even more interesting, the insurance companies cannot 
charge whatever they want. Remember that they are in competition with the 
other insurance companies that do business in their area. If they price 
themselves too high, the competition gets the business. They're working with 
mandates, they're working with escalating prescription drug prices, they're 
working with expensive new technology and probably, for the most part, doing 
the best that they can, and cutting back on what they *believe* is less 
important. What's important depends, of course, on your perspective. 

Anyway, I hope you get the general picture. And, no, I don't work for the 
insurance industry. I was a business writer for a long time.

Jan and Elvis
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