But my insurance will cover it, RIGHT?

Ashabil Rizhana

Ashabil Rizhana

Operations Manager


Ah, the insurance-backed healthcare system. It's a roller coaster, often feeling like you're playing a game of "Will they? Won't they?" with what's covered and what's going to leave you checking under the couch cushions for extra change.


Let's dive into a scenario where you, the patient, walk in with a problem—say, a broken bone. The doctor’s first thought isn't the best medical response but rather, "Will insurance cover this?" If you think about it, it's kind of like having a third party lurking over the doctor's shoulder, nodding or shaking their head. Not exactly the personalized care fantasy I have in mind!


One word: Expensive


The costs of some procedures can make your wallet try to file for independence. Prices are through the roof, primarily because they are expected to be shouldered by insurance. This inflation makes the insurance agencies flourish but leaves everyone else in the land griping over their paid taxes.


Imagine walking into a candy store, but you're only allowed to pick the candies that someone else decides are right for you. This isn't a stretch from the patient's experience in an insurance-backed system. You might have a directory of doctors as long as a child's Christmas list to Santa, but your actual choices for covered care aren’t as expansive.


Then we have the medical equivalent of "measure twice, cut once". Over-investigating, over-diagnosing, over-treating; it's like the healthcare system is on a shopping spree with someone else's credit card. Why? Simply put, services equal reimbursement. 


For example, if you go to a hospital in India with a sprained ankle, the minimum protocol is an X-ray, while on the other hand, in the US it could land you in the MRI machine before you can say, "Insurance".


The Intermediaries aka TPA’s


Between hospitals and insurance companies are these folks who—albeit help to ensure that claims are filed and managed—also add another layer of complexity and cost. It's like having too many cooks in the kitchen, except everyone's meal ends up more expensive.


So, where does that leave you? Well, it's not all doom and gloom. Awareness is the first step toward change. And hey, maybe it's time for some mavericks in the health-tech game to introduce innovations that tackle these systemic inefficiencies head-on. 


In the grand scheme of things, it's clear that the insurance-backed model has its issues. But, by understanding the ins and outs, we can start to imagine—and work towards—a system that puts the patient (yes, that's you) first. And if you haven't yet, do check out "The Innovator's Prescription." It's an eye-opener.


Until next time, keep your insurance card close, but your healthcare knowledge closer.

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