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Insurance Won't Cover Smartphones, When Pricey Alternatives Exist
consonant writes "The NY Times has an article on insurers refusing to cover cheaper devices such as iPhones and netbooks which may be used by the speech-impaired, and instead requires them to acquire devices that cost from 10 to 20 times as much. The reason? 'Insurance is supposed to cover medical devices, and smartphones or PCs can be used for nonmedical purposes, like playing video games or Web browsing.' From the article: 'For the millions of Americans with A.L.S., Down syndrome, autism, strokes and other speech-impairing conditions, the insurance industry's aversion to covering mainstream devices adds to the challenges they face. Advocates say using an everyday device to communicate can ease the stigma and fear of making the adjustment. At the same time, current policies mean that the government and private insurers may be spending unnecessary dollars on specialty machines.'"
No, really, it's everywhere.
A few years back, I had to have an operation on my foot. The doctor said he could do the operation in his office under local anesthetic and the whole thing would cost a couple thousand bucks (memory's fuzzy), or we could do it in a hospital where it'd be 5x more expensive. The catch? My insurance would cover the hospital outpatient surgery, but not his office (which was also a fully licensed and certified surgical center, just not attached to a hospital). So I did it in the hospital, of course; I was between contracts and couldn't afford to do otherwise even if I had felt noble enough to do it for the good of the health care system.
Misguided incentives like this are all over health insurance--just look at the varying coverage rates for preventive care vs. corrective care (like diabetes maintenance vs. amputations). If you can put off the treatment until later, there's a reasonable chance that some other insurance company will pick up the more expensive tab, and "patient outcomes? What's that?"
It's one of the strongest arguments for a single-payer healthcare system: the chance to remove loopholes that lead to these bad incentives.
Freedom isn't free; its price is the well-being of others.
Yeah, they would. I mean, sure, they'll go for the medical device if it's better, but if a simple iPhone would work nicely, they'll get you an iPhone. Mainly 'cause in Scotland at least, that sort of decision is made by the local manager in the place you actually go to see the doctor/physio etc. The great thing about the NHS is that it divorces cost from medicine. Since it's all "free" to the patient and the doctor anyway, the doctor will go for the best medical option, regardless of if it costs less or more; admittedly there is some shilling still of GP's by big Pharma trying to get them to prescribe brand X drug, but it's mostly gone, and we see a lot more brand-x-generic now, and all gratuities from Big Pharma to the GP have to be declared. In the States, even if you get coverage, your insurance co. still get shafted by doctors that will order unnecessary tests etc. just to bump up the bill, because it's not his company the money's coming from. Here, it's all the same "company", so if you need a test, you get it. If not, you don't. On the bad side, whilst they'll never turn you down for treatment, depending on where you live, and what it is, you may be waiting a while for that hip-replacement/eye-operation etc.
The truth shall always be free: Boris Floricic is Tron.
The article is about Medical Insurance (HMO's, etc) paying for consumer devices such as iPhones and software to run medical uses, such as a speech generator for those that cannot speak for themselves. Currently they will pay for expensive, more customized devices. THIS ARTICLE IS NOT SPEAKING AT ALL ABOUT REPLACEMENT OR LOSS INSURENCE!
That is because each state has different laws covering health insurance. There is no government regulation preventing you from purchasing insurance from a carrier in a different state, nor is there regulation preventing an insurance company from selling in multiple states.
100% false. You can deduct medical insurance premiums.
This is a separate issue, and one worthy of debate. The alternative to mandated coverages (which are much less onerous than you assume, I think) is insurers selling insurance, collecting premiums, then denying claims for seemingly random conditions. This was a HUGE problem before states stepped in to regulate the medical insurance industry. While it needs to be balanced against efficiency, there is no doubt in my mind that mandated coverages have been a big benefit to insurance buyers.
As for the first two items I addrsssed, you are either being disingenuous or are grossly misinformed. I hope it's the latter, but I'm not sure.
While I agree that over-regulation can be a problem, under-regulation can also be a problem. Letting the insurance companies do what they want will not result in a better outcome for the people who buy insurance. We've been there, and it doesn't work. My big complaint with over-regulation is that it creates barriers to entry due to compliance costs; however, there are already significant barriers to entry in the medical insurance business because of the cost of catastrophic cases (capital reserves need to be very large, which keeps new entrants out; also, bad luck could easily mean insolvency for a small insurer).
"Trolls they were, but filled with the evil will of their master: a fell race..." -- J.R.R. Tolkien on Olog-hai
Because insurance companies tie their definition of "medical device" to what Medicare reimburses for (one of the reasons for this is that Medicare constitutes such a large part of the market for people using medical devices that insurance companies find it cheaper to use their list than generate one of their own). And since Medicare has certain legal requirements for what a "medical device" is (including going through FDA approval), it can be expensive and complicated to get on that list. Hence, any device that is on the list is going to cost much more than one that isn't. The alternative is to let Medicare bureaucrats, who are not doctors, decide whether a device is medically necessary or not.
So you're not naive about how health insurance works. You've naive about how government programs in the United States work. Now maybe you can understand why most of us don't want the Federal government to have anything to do with health care: they'll just make it worse.
God invented whiskey so the Irish would not rule the world.
You'd have to meet a certain level of proof for said disability for them to provide the expensive stuff- so why would it be any different for the "fancy PDA's and Smartphones".
I've been involved with discussions on designing one of those special purpose devices on the cheap with the design and the software being open-sourced in the past. Touch-boards are heinously limited in their vocabulary and grotesquely overpriced. Take a touch-screen netbook type device and put a customized Linux distribution on it and now you have the same thing, but unlimited in vocabulary and roughly 1/3rd the price.
These "special purpose" devices are waaay overpriced in many cases.
I am not merely a "consumer" or a "taxpayer". I am a Citizen of the State of Texas
So, deny an inexpensive claim, instead favoring an inferior-and-single-task solution costing 10x to 20x more? Not only are they superior to teletype-like machines in every single way, they give the disabled the ability to communicate from ANYWHERE, not just tied to a bulky single-purpose computer and hard telephone line.
The Christian Right is Neither (Christian nor right). See: Matthew 23, Matthew 25, Ezekiel 16:48-50
Yeah, in our system, we may pay a lot more money and get worse results than, you know, everyone else in the developed world... but hey, at least we don't have government bureaucrats* getting between us and our doctors! USA! USA!
* Instead, we have bureaucrats from the for-profit insurance companies, who make money by denying us care, and answer to no one but their stockholders.
Then we'll never agree. I think you sell short the ability of private concerns to scam their customers, especially when they have the resources to buy the laws they want. What we have now is a system where the insurance companies are a scam, and the government supports them because insurance company money gets people elected. So we have an even more effective scam. Removing the profit incentive from the insurance business will reduce this.
That's disingenuous. You can opt out of the government system and go with a private carrier, and not pay any fine. The reason the uninsured will have to pay a penalty is because the general public (or hospitals private or public, currently) will end up paying for their care anyway. The penalty keeps people from freeloading on the system, which is a big problem when you have a mixed public-private system.
Are you talking about car insurance? Because in most states, you are either required to pay for insurance, or required to pay a fine if you are uninsured. Not sure how this one supports your argument...
"Trolls they were, but filled with the evil will of their master: a fell race..." -- J.R.R. Tolkien on Olog-hai
Wow. You must get all your new from biased sources since you have everything backwards.
Buying insurance as an individual is incredibly expensive. The reason employers get a better deal is because they have a larger pool of people and can negotiate down prices. As an individual, you do not have that leverage so you get screwed. You are also screwed no matter how much you are willing to pay if you have a pre-existing condition (like pregnancy).
A public option would allow you to take it across state lines...so I don't know what you are complaining about there.
You are already paying for coverage you never use. And on top of that, you are paying for all the profits that go to the shareholders and the large CEO salaries. There is no way that it will be more expensive than the current system.
Again, one device being preferred over the other is already in the current system.
It has gotten vastly better for every industrialized country that has a single payer system. The mantra that government is bad is stupid and childish. Too much government is bad. Too little government is bad. It is time to realize for our businesses to compete and for us as individuals to be actually getting raises instead of paying more for health care, we need to do away with the for profit business of health insurance.
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This is an important point.
The medical classification (from the government) for this type of device is "speech-generating device." This is a really old term from back when speech synthesis was computationally difficult (AT&T DECtalk was state-of-the-art) and portable computers were expensive. Professionals in this field refer to them instead as "augmentative and alternative communication" because we acknowledge that there is much more to communication than just speech.
The rules limit assistive tech to only the vocal mode, which isn't natural... people without disabilities communicate in a variety of ways. The mode that I am using to communicate with you right now is just as natural as oral speech, but I require an augmentative device to do so.
There's a perfect xkcd for my sig but I'm too lazy to look it up. sudo someone go find it.
About two-third of the staff inside UK Health Services are bureaucrats, not medical personnel
More excuses for inhumanity.
I don't have the latest survey to hand, but http://www.statistics.gov.uk/STATBASE/ssdataset.asp?vlnk=7780 lists to 2002 percentages for England:
7.7% Medical and dental (doctors)
31.7& Nurses, midwifes, and health visitors
11.2% Scientific, theraputic, and technical
31.5% Support to clinical and other staff care
17.3% NHS infrastructure staff
Some of the nurses and clinical support staff will have administrative duties, but at least half of the total are involved with direct delivery of care.
The table at http://www.ic.nhs.uk/webfiles/publications/nhsstaff/NHSStaffNHSLeaflet240406_PDF.pdf lists 2005 statistics and gives breakdowns on non-admin staff. The short summary:
10% Doctors
30% Nurses and therapists
10% Scientific and technical
1.3% Ambulance drivers
28% Support to doctors and therapists
That might be what insurance should do, but its nothing like it does do. Heck, health insurance (in the US) doesn't even cover drugs that don't require a prescription, even when they are recommended by a doctor and the most effective means of dealing with a condition.
As somebody who spent a lot of time and energy helping acquire such a device for his father who suffered from ALS, I would like to highlight some important facts.
Many of the devices that the insurance companies cover are actually modified PC's. Before you say that people are better off buying a computer and having insurance foot the bill, look at the facts:
1. These PC's come modified with software and other interfaces which are specially designed based on years of research to meet the needs of the disabled for communication in the most intuitive way possible.
2. Often times the software is placed on an embedded windows system so that its harder to "break" with malware, and the like. Very few PC owners apart from the tech savy can say they've never gotten a computer virus or some form of malware. Even us techies slip up sometimes. Can you imagine if your lifeline were disabled by a virus? This is exactly what these devices are. Lifelines. People rely on them every day for the basic things we take for granted. Having the software embedded keeps the device functioning. Having functionality limited to...well....speaking...that makes the device far less daunting to those who might not be as computer savvy.
3. There are lots of different attachments available for these devices that let pretty much anyone with any level of disability use them. Each attachment is geared towards using the functionality a person has left. These are niche items that are pretty hard to come by at WalMart.
4. These computers are generally ruggedized (usually a toughbook, or something similar). The ruggedization is critical when the device goes everywhere with you.
The bottom line, really, is that these devices are designed to work any time anywhere for anyone. These are really custom solutions. Also, a whole lot of vendor support comes with the device, which is critical to making the most of it. This entire package, including the support, the level of customization in terms of input devices and software tools, and the level of quality and reliability seem to justify the high price in my eyes.
Your insurance company, believe it or not, has your best interest in mind as well as their own when they decide what is and isn't covered. These costly specialized devices are the best option for a whole lot of people. By only covering a solution like this, the insurance company knows you're getting what you need, which is tough to do if you're talking about building a system yourself.
I could have created a home-brew solution, but it would have been without the benefit of years of research into the progression of various diseases and the capabilities of somebody paralyzed from the neck down. Why should a patient have to deal with debugging a home-brew solution or trying to use a conventional mouse or keyboard when they can barely move their fingers? Being paralyzed is frustrating enough as it is...they don't need the extra stress.
On a side note, you can in fact work with the vendor and the insurance company to have an "add-on" placed in the computer-turned-medical device to allow you to use it as a computer as well. The expense is out of pocket, but is usually far less than the cost of a computer.
izm
In agreement with your post: a few months ago I listened to an analysis by a sector banker of the ABN Amro (a large Dutch bank) about freelancers. He said the biggest reason for the lack of freelancers in the country where you'd expect the most, the USA, was lack of affordable health, professional and disability insurance.
So in The Netherlands (you know, Fox's posterboy for all that's bad with socialized healthcare) more and more people are self-employed because it's doable (and much more so since the government changed the healthcare insurance). Here I insure my entire families' health for 330 euro's a month - and that's with one of the more expensive full-coverage, choose-your-own doctor/hospital/whatever insurers.
Therefore, by the (faulty) logic you're using, you're just a cow with a keyboard - osu-neko (2604)
"Medical insurance" in the United States isn't really insurance so much as it is a third-party payer for the vast majority of your medical bills.
Exactly. I want health insurance, so that, if I get cancer tomorrow, my wife and son will still have a place to live in five years. Unfortunately, we can't get that. We can get companies that promise to pay those expenses, but, if something really goes wrong, they will find a way to weasel out of it. So, the only product available in the states is the "frequent sicko discount club", and you have to get that from your employer.
I'm so glad that we have congress to protect us from an alternative that does not skim off the top, and ditch us at the first opportunity.
"The alternative is to let Medicare bureaucrats, who are not doctors, decide whether a device is medically necessary or not. "
Those 'bureaucrats' are advised by doctors/medical experts.
"Now maybe you can understand why most of us don't want the Federal government to have anything to do with health care: they'll just make it worse."
75% of doctors want a single payer plan. http://seminal.firedoglake.com/diary/8141
And it is still roughly 50% of the American people who want reform (depends on the poll/time, but hovers around 50%).
The other 50% have been watching fox news or something I guess... :)
We are the only developed first class country on earth without government run healthcare, and we pay more per person than any other country, and according to WHO statistics we are behind on many quality measures. The only thing we are better at is rare disease/cancer treatments, which doesn't benefit the masses.
So tell me again why Private Insurance is better?
Cost? Nope.
Quality? Nope.
Ability to offer coverage to a wider audience? Nope.
Whether you like it or not, you are indirectly paying for the uninsured by higher healthcare costs. Every time an uninsured person waits until they are very sick, walks into an emergency room, and has an extended costly hospital stay, you and I pay for it.
Not quite. Medical expenses are only deductible if they exceed 7.5% of your AGi, and you need to itemize, meaning that this deduction competes with the standard deduction. Contrast this with employer provided healthcare: you get to deduct all of it, and you can still take your standard deduction.
In both cases, this favors the rich.
Given that California, at least, allows MM treatment for virtually any condition, including depression, I find it hard to accuse basically healthy people who use it of fraud. There is no provision that says that other treatments must be tried before marijuana, nor a provision that you need be deathly ill to take it. Nor should there be if you ask me. And if there's some hippie doctor out there who'll recommend it to anyone then so be it. It's basically harmless. For every one of him there's a hundred "normal" doctors who will not prescribe it under any circumstances because they're too afraid of the Federal bogeymen coming to cart them off for doing their job.
The risk is basically that people will effectively self medicate with MM, since you only need to get recommended once, where they might be better off with another medication. Guess what? Not everybody has the time/money/gumption/whatever to see a shrink twice a month. In any case, MM is safer and cheaper than all of the meds they're prescribing. The alternative to this "fraud" is needless suffering.
Of course if the Feds were to wake up and say "we respect the right of the states to self determination wrt drug policy," we could better control pseudo-illicit use of MM. But that'll be a cold day in hell.
1. You don't speak for the majority, unless you're omniscient and I don't know it.
2. You certainly don't speak for me, as I consider it a total failure for healthcare reform and a total victory for the insurance companies if the reform bill lacks a public or single payer option.
3. I've personally spoken with citizens of other countries. Denmark has a single payer system, and the person I spoke with had nothing bad to say about it. In fact, the more we spoke the more interested I became in learning Danish and moving. The Canadian fellow pays a total of 92 USD a month for coverage that makes our government employee benefits package look like a complete joke. And their income tax bracketing system is simpler and results in less paid in taxes than hours.
4. I heard on NPR just this afternoon that most doctors would prefer a public payer option and 10% of which would even prefer a single payer option. And I think they would know better than I, or even you.
So perhaps the US government would royally screw it up, but if the Canadian or Danish examples are any measure, it's a lot better than letting private companies run the show when there is money to be made.
Question everything
me: "We are the only developed first class country on earth without government run healthcare"
him "That's not entirely accurate. Canada does not have a central-government run health care system, either. Each province has their own system. "
Ya, I didn't mean federal/central government only. State/Provincial governments are included.