Is your health insurance hurting you?

Health coverage and quality care should be synonymous

Elaine, a 55 year old healthy woman, had routine surgery that would require a 2 to 3 day stay in the hospital.  Elaine, who is covered by a private insurance provider, suffered complications and had to stay in the hospital an extra 5 days.  Elaine’s friend, Robin, who is also healthy, had the same procedure done.  Robin, who paid for the surgery “out of pocket”, had no complications and went home early; into the second day of post-surgery stay.

While there are many factors to consider, such as how the body heals or reacts, a recent study in The Journal of the American Medical Association (JAMA), suggests that patients receive better care if they have no insurance or little coverage, while patients with good coverage have a higher rate of post-surgical complications.  

Simply stated, your insurance has the potential of causing you harm.  Anyone who suspects that their post-surgical complication resulted from lack of care or negligence may have a medical malpractice claim.  

People spend thousands of dollars a year on a health insurance that promises a good coverage.  Medical professionals should not base attention and level of care on your insurance.  Regardless of one’s insurance coverage, all patients should be given an equal amount of attention and care.  No patient should enter surgery, worrying if their surgery is not their surgeon’s number one priority nor should they worry about becoming a victim of medical malpractice.

The JAMA study

The study is based on detailed analysis taken from the records of 34,256 people who had surgery at one of 12 Texas hospitals in 2010.  Of those patients, 1,820 had at least one preventable surgical complication such as blood clots, pneumonia, or an infected incision.  Additionally, the complications end up costing more and some patients’ bills increase even more if they are forced to stay in the hospital for a longer period of time.

The average length of stay for those patients was 14 days and the hospital revenue averaged $30, 500 more for patients without complications: $49,400 versus $18,900.  On average, private insurers paid far more for complications than did Medicare, Medicaid, or patients who had no insurance or paid out of pocket.

Many medical professionals and administrators doubt that the lack of care and carelessness in the operating room is intentional; many suspect that patients with poor to little coverage are given more “focused” care because the hospital will not be paid for any additional length of stay or complications that occur.  In an effort to encourage better care for all patients, Medicare and some private insurance companies refuse to pay for care if a patient had to be readmitted after surgery, if the hospital or doctors got “poor ratings”, or if preventable medical errors occurred.

Our future as patients

While many individuals are fortunate to have a good insurance plan, others do not.  Considering the JAMA study, many with good insurance may be tempted to have little to no insurance.  When looking for insurance, do not sacrifice a good insurance plan just because you fear it will cost more, financially, emotionally, and physically, in the future.  

If you have suffered unnecessary complications due to carelessness in the operating room, it could be related to your insurance plan or it could be related to any number of things.  Regardless, if you have been mistreated in anyway, you have a malpractice claim to file.  Don’t let your insurance, good or bad, affect the medical attention you deserve!

About the author: Andrew Miller is an Avid Legal Blogger, environmental law student, and author. Find him on Twitter @amillerblog

* Image license: Andrew Miller