Australian Private Health Insurance

Tim and I took out private health insurance here in Australia. We became eligible for Medicare - Australia's public health insurance - in October. Even with the public health program, many people who can afford it, take out private insurance as well. For one reason, there is a tax rebate for people with private health insurance. I assume the reason is that private healthcare relieves some of the stress on the public system.

There is a general rule here, that if you have had hospital coverage prior to enrolling in a new program, that your benefits will continue if you enroll within two months of terminating your last insurance (hence no 2-month waiting period or pre-existing condition clauses). There is some question whether our expatriate coverage that was provided through CSIRO (until Medicare became effective by becoming permanent residents) is eligible for this 2-month continuation rule. The interesting item here, is that our new health insurer is helping us get that continuation of coverage - i.e., save us money which could potentially cost them money!

Comparing this to our experience with Cigna - well, in fact there is no comparison! I had to fight Cigna for almost every claim I ever made, which usually meant dealing with some very unpleasant (read: rude and abusive) Cigna employees.

I know that the USA doesn't have public health - unfortunately - but why can't US insurance companies be less adversarial? Why can't they pay claims without going through all the games of denial - so that only the most persistent of people get reimbursed?

I am not afraid to talk to people who work for our new health insurance. In fact, the people I have dealt with are absolutely lovely. One woman has been trying different avenues to allow us to get the continuation - going out of her way to help us! I have never had that happen to me in the United States - in dealing with health insurers. I actually dread every time I have to speak with Cigna, because I know it will be stressful, and it usually means more of my time to "justify" to them why they should pay my claim.

I have been reading about Cigna, which includes Cigna forums online. Apparently, the morale at Cigna is at an all-time low. Several employees said they have to perform the jobs of 2 or more people. One person said their insurance benefits were poor. It doesn't seem surprising to me that employees would have low morale - for all the reasons stated and because they are encouraged to hang up their ethics before entering the place of work. How satisfying can it be to constantly say "no" to people - which possibly means going against their own better judgment or nature? The more you deny claims the more you advance in the organization... does this sound right, moral or good?

The Health Insurance industry in the US needs an overhaul. Perhaps they could learn something from Australian insurers?