In the US:
We’ve all heard the horror stories;
- Kicked out of hospital early
- Uncertain access to specialist hospitals without right insurance plan
- Treatment limits which cause bankrupcy
- Record policy costs
- Record profits for health insurers.
The Health Insurer Controls
Your doctor, your hospital, your treatment plan and cost spent on your health according to their network contract provider agreements.
You must choose from the list of providers they contract with.
If you want a doctor “out of network” your insurer doesn’t cover you.
If your chosen treatment or hospital is “out of network” your insurer doesn’t cover you.
Not all company health plans are the same with many levels of network coverage depending on what contracts the insurer allows and what your employer can afford.
What has happened in Australia?
Over the last 5-10 years we have seen the stealthy creep of health insurers into the treatment pathway.
Each encroachment is small and in a grey zone, but collectively the intent is clear and the major “for profit” insurers are each testing the water in different ways.
In 2017 Bupa, a UK health insurer, introduced restrictions on which hospital you could attend, by only insuring gaps if the hospital was a Bupa network provider.
In 2019, Medibank Private began to buy hospitals in order to begin to vertically integrate services.
In 2022, Medibank Private continued to buy, build and commission day surgeries which appears to be a slow but steady attempt to become an end to end health provider – your health choices now in their pipeline.