Re: "Utilization Review"

At  7:01 PM 8/20/96 -0400, Alan Horowitz wrote:
>If you want to convince the masses - or even fashion elites such as myself
>- to forego recourse to voluntary risk sharing.... you have your work cut
>out for you.

The insurance companies have every reason to perform "Utilization Reviews",
since only they have incentive to contain costs.  Our medical plans tend to
insure for routine medical care and as a result, give the insurance
companies the data about our routine care.  If they only paid for
catastrophic illness and accident care, they would only have reason to have
data on that care.

Do you want to share the risk of routine medical care?  Or do you just want
to share the risk of catastrophic illnesses and accidents?  Or do you want
to keep it all private.  What you pay for, you can keep private.  What they
pay for, they can review.  Your choice.


-------------------------------------------------------------------------
Bill Frantz       | Cave ab homine unius lebri | Periwinkle -- Consulting
(408)356-8506     |  [Beware the man of one    | 16345 Englewood Ave.
frantz@netcom.com |   book]  - Anonymous Latin | Los Gatos, CA 95032, USA

On Tue, 20 Aug 1996, Bill Frantz wrote:

> Do you want to share the risk of routine medical care?  Or do you just want
> to share the risk of catastrophic illnesses and accidents?  Or do you want
> to keep it all private.  What you pay for, you can keep private.  What they
> pay for, they can review.  Your choice.

Oh, that's a different kettle of fish entirely. As a matter of fact I do
have catastrophic coverage only ($2500 annual deductible and other
limitations), but were I less hale and youthful, or had I a family, I would
probably opt for "managed care."

However, you'll find that catastrophic coverage really isn't that much
cheaper than full "managed care," because without intimate knowledge of my
habits and detailed records of regular doctor's visits, the insurance
company doesn't trust me as much as it trusts a "managed care" patient.

-rich