I am no expert on health insurance, although I did work as a customer service representative at one of the country's largest health insurance company. That gave me a first hand view of the other side. Believe me when I tell you that when the company polled its workers to see what their biggest complaints were by workers, the number one complaint was stress. While I didn't do a survey, I can tell you what my experiences were, and share some information I received in talking with others that worked there.

For me, and for others I talked to, the biggest stress creator was that when a customer called to find out if a test or procedure was covered there was no easily defined way to know. We could look at the plan policy, but that depended on what type of plan it was. Was it employer funded or insurance company funded? What CPT codes were going to be used? If the right ones weren't used it might not be covered, or only partially covered. Sometimes, the plan would say it was covered, but then there were notes that may indicate that the policy had changed. Sometimes the notes were at the end of the policy, sometimes they were somewhere else.

Also, some procedures had complex requirements that had to be met before it would be covered. While we could read the complex requirements full of medical jargon, we could not explain what they meant because we were not doctors and there was too much liability with explaining them; we had to suggest they get clarification from the doctor. It was not too uncommon to have to send a request to a claims processor to find out if a procedure would be covered. Even then, it might take days for the processor to discover the answer. The calls we took that we couldn't answer right away were put in our queue. It was not uncommon for my queue to be so full others would have to help me. I was told that it would take three to five years to get enough information to help these callers on the first call, even then that information could change within that time.

This was so common that I couldn't hack it there. I am a problem solver, and not being able to help these people stressed me out to the point it was taking a physical toll.

Based on my experiences, here are my suggestions on health insurance reform.

First, health insurance should only be for chronic and catastrophic situations. I understand that regular check ups can help prevent and catch problems early. Insurance companies say that early prevention lowers costs because it helps prevent higher costs for health problems found later. If this is true, then why is it that health insurance companies have continued to increase health maintenance and preventative care into health plans, but the plan costs continue to skyrocket? It would seem that instead of lowering costs, adding preventative care increases costs. Has anyone had their health insurance price go down in the last five years? Also, why are plans that cover preventative care more costly to the consumer than catastrophic only insurance plans if they help reduce costs?

A health plan that covers only chronic and catastrophic care would place the burden of preventative care on the consumer, which would allow that consumer to shop and compare prices. If health insurance companies believe that preventative care is helpful, then they can take a page out of the automotive industry. There are car repair insurance companies that require proof of maintenance. They don't pay for maintenance, but they require proof from the customer that they have performed routine maintenance on the car before they will cover some engine related repairs. Perhaps, the health insurance companies can require preventative care for customers that want a lower health insurance rate.

Second, health insurance is a contract between the health insurance company and the consumer. If a health insurance company drops a contract, then the consumer should have rights to sue for damages. If I, as a consumer, fail to pay my health insurance, then the insurance company can rightfully drop my coverage. However, what recourse does a consumer have when, after fulfilling their side of the contract, the health insurance company, in effect, breaches the contract. I understand that the health insurance company probably has a provision allowing them to drop the consumer at any time, but is it legal? Can a health insurance company take money for services that it doesn't provide? Would it be lawful for an online company to accept money from a customer and then decide not to ship the product?

Third, I have sympathy for health insurance companies when it comes to pre-existing conditions as a business person. However, I also have sympathy for the consumer. It isn't right for a person to wait until they are ill to purchase health insurance and expect that company to cover them. It also isn't right for a health insurance company to drop a customer that has an illness and expect that customer to be able to find a difference health insurance company to cover them.

Part of this problem could be solved by having individuals or families purchase health insurance policies instead of employers. It is not uncommon for a person to lose their job, and therefore their health insurance, because of an illness. If plans were tied to individuals it would be possible for the individual to retain their coverage, without an explosive price increase. The price of coverage should also not be determined by the employment status of that person.

Fourth, the CPT codes that are used in billing insurance companies should be more clear. There were times I had to tell my own doctor the proper code to use to get coverage from my health insurance company because the code definitions were unclear and ambiguous. There is no reason one or more full time members of a doctor's staff should have to be dedicated just to communicating with health insurance companies to ensure that they are billing properly. CPT codes should be standardized across all health insurance companies and government funded health insurance companies. Those codes should be clearly defined, and the coverage of the patient should also be clearly defined, with the proper CPT codes to use for each covered benefit.

Fifth, this has been discussed many times. Health insurance companies should not be confined by state borders. Health insurance is a service that can be sold over state lines and should be made regular. No state should be allowed to limit trade from other states.

Sixth, this has also been discussed. Legal reimbursement for pain and suffering should be limited to one million dollars. Some say two hundred fifty thousand, but if a doctor is extremely negligent, it would be good to be able to send a strong financial message to that doctor. Frankly, two hundred fifty thousand is chump change for some doctors. One million dollars might do a better job at getting their attention.

I realize that my microphone is small here, but I hope that those that read this will spread the word that conservative health care reform can't be just market based. It also has to include the idea of liberty and justice. Contract law was an important principle among our founding fathers. I think health insurance coverage touches on contract law. Can a health insurance company take payment and not disperse a product? Can the health insurance company break the contract to prevent further disbursement of the product after payment has been made? Generally, the answer is that it depends on how the contract was written, but if a contract is written to say that no product is guaranteed for payment rendered, then is that a legal contract. Doesn't that go back to the sale of snake oil? Is the company making claims it doesn't intend to keep? Would we allow drug companies to claim their drug cures cancer, but in the contract write that it may not? Why do we allow insurance companies to claim to pay for health care when there is a significant chance they may not?

These are all things I feel aren't being discussed enough by conservatives. Conservatives like to shout about small government, but then when it comes to regulation they sometimes act as though there is no government. Ideally, all of these ideas would be taken up by the states, except for the sale of health insurance across state lines which deals with interstate commerce. Let's be diligent to ensure that our Constitution and the principles our founding fathers advocated is followed while dealing with health coverage reform. I believe that will lead to more people able to be covered, without growing the federal government and without losing our liberties.

I heard on Glenn Beck's radio program today that the senate killed S 604 Federal Reserve Sunshine Act of 2009. I decided to try to find out who supported the bill. According to GovTrack there were only three cosponsors of the bill. Those cosponsors Senator Michael Crapo (R-ID), Senator Jim Demint (R-SC), Senator David Vitter (R-LA). This means that anyone who did not cosponsor the bill must not believe in financial accountability for the people that control the United States money.

If your senator isn't on the list of cosponsors, perhaps you may want to contact them and ask them why they are in opposition to financial accountability.

They may be inclined to say that just because they didn't cosponsor the bill doesn't mean they don't support the bill. Don't believe that lie. Inaction is passive opposition. If the senators cared about the people of the United States, and if they cared about their constituents, then they would not have let the bill die. By letting the bill die, they send a clear message to the people of the United States that they do not believe in government accountability and do not believe in accountability for the people that are responsible for managing the United States dollar.

I encourage you to let your senators know how you feel about that.

Recently, I heard that the house would be voting on a "cap and trade" bill very soon. Wanting to be a good citizen, I emailed my representatives to let them know that I do not want any so called cap and trade bills. In response, I received some interesting information from Congressman Mark Souder's office. He sent me a cost allocation map that shows how the "cap and trade" bill would affect the cost of energy by state.

After looking at the map, it doesn't take long to see that the Midwestern states are disproportionately affected by H.R. 2454 in a negative way. Of course, that is not to say that I think all states should be equally negatively affected; I don't think any states should be affected by this bill because I don't believe it should pass.

Cost Allocation Map 06 10 2009.pdf (89.19 kb)

If you agree that this bill should not pass, then I encourage you to email your representatives and let them know that this is pissing you off.

With the Federal Reserve in large part to blame for the current economic situation, and the fact that President Obama wants to empower the Federal Reserve with the authority to take over any business it deems necessary, auditing the Federal Reserve, a non-government entity, is the minimum that should be done.

The Federal Reserve is responsible for ensuring that there are no financial problems in our economy, and yet, since the return of the Federal Reserve, previously known as the Bank of America, under Woodrow Wilson in the early 1900s, there has been increased financial volatility. Some may argue that the people running the Federal Reserve are the problem, not the system itself. I partially agree.

One issue I have is that when you have a centralized power structure, like the Federal Reserve, you create an environment where group think can occur. Group think can occur in the Federal Reserve and in the government. It is no stretch to believe that if a member of congress disagrees with a member of the Federal Reserve that the Federal Reserve member could intellectually embarrass the member of the government, and do it with impunity. This creates an environment where government may be right in their ideas, but because of fear they don't speak up. Unfortunately, our society has propagated the idea that only an elite group of people are able to conquer such complex ideas, but that is a different article. Nothing could be further from the truth. We are all intellectually capable. It is only our will that prevents us from climbing to such intellectual heights.

There are many other reasons that the idea of the Federal Reserve should be done away with, but let's at least have the government audit them. After all, every other company in the United States has to file with the IRS. If you agree, click the link below and show your support.

If you are looking for some corny entertainment about auditing the Federal Reserve, here is a video that might make your day.