Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
In the wake of the murder of United Healthcare CEO
Brian Thompson. The insurance industry in general has been under
the microscope and has taken a lot of fire, and
there are so many issues here that it's complicated to
try to to do justice to it in a relatively
(00:22):
short segment. But if anybody can, it is our official
evil insurance man of kfab's Morning News, Art Jedter of
the Art Jeter Company, longtime insurance executive.
Speaker 2 (00:32):
Our good morning, Good morning Gary.
Speaker 1 (00:34):
Great to have you here. Is there a generalized or
thumbnail version of the insurance industry response to the criticisms
that have been raised in the wake of this murder.
Speaker 2 (00:49):
I don't know if I speak for the entire industry,
but I think I hope we can agree that there's
absolutely no justification for murder people who makes a statement
or the selves or themselves creating a problem. I just
ask if they were able to look in the heart
of the victim or they just make an omption. I've
met many CEOs over my years in the business, and
(01:12):
I've heard more than one say something like, my objective
is to provide more value to our policyholders. So I
think it's a very sad state of affairs when people
try and justify this sort.
Speaker 1 (01:26):
Now there's no question about it. And the sad fact is,
of course that we can't all agree that the murder
wasn't justified. I would hope that in this contry there's
an overwhelming majority of people that would agree to that.
You know, one of the things that and Art and
I have chatted about this before. One of the things
that gets lost. And I'm not going to claim to
(01:49):
be an expert in anything, and I'm not saying the
insurance industry is blameless, but you never hear you certainly
don't hear it in this case about they provide the hospitals,
the medical associations, the doctors and so forth, and the
costs that you see on your bill when you have
some kind of medical procedure or inpatient visit or whatever.
(02:14):
It is enormously expensive. That parton never guess mentioned, ark No,
But we all want.
Speaker 2 (02:22):
Our health insurance companies to our health and insurance plans
to pay for pay for our costs or for our
healthcare costs. It's the lowest possible cost to us, the
lowest premiums, and we don't want our premium to be
any higher than necessary. But I would like to say,
you know, we've heard about the denial rates of claims.
I looked into that particular company and their denial rate
(02:47):
is not as high as being reported. And what's interesting
is they pay eighty percent of their claims when submitted
eighty seven percent, and of the remaining thirteen percent, only
one percenter denied due to clinical reasons, the other the
other twelve percenter due to administrative errors or missing information
(03:08):
or duplicates or non covered services. And you know, I've
been asked more than once what's a non covered service?
So I'll give you an example. Medicare pays one hundred
percent for twenty days of skilled care at a facility
when it's rehabilitating. But that that often gives people the
idea that Medicare will pay for custodial care in a
(03:30):
facility when the time comes when someone can no longer
dress or feed themselves, that sort of thing. But Medicare
pays for skilled rehabilitating care and does not pay for
custodial care, so those claims come in that would be
an example of a non covered service. I just say
that if you want insurance, it pays for long term
custodial carry, you need to buy long term care insurance nets.
(03:55):
But that would be an example of a non covered
expense that I notice. Go ahead here, Well, I know
this is basic logic, but the cost of insurance is
directly directly related to the costs pay for care, just
like you were saying. And so people who buy insurance,
(04:16):
who pay for insurance don't want their insurance plan to
pay for things that aren't supposed to be covered, and
so there has to be some sort of review process.
We don't want our health insurance to be subjected to
scams or fraud or waste or abuse. And when insurance
plans find those they just if they don't catch them,
(04:38):
it just drives up all of our premiums. So everyone
should want a process where those kinds of things are challenged.
Insurance companies are the ones that catch those scams and
waste and abuse.
Speaker 1 (04:53):
Is there anything? A lot of people and part of
the literature I've read is that, yeah, if you have
a claim denied and you believe it's legitimate, you should
appeal it and make your case. A lot a lot
of people are difficulty navigating that. Is there?
Speaker 2 (05:13):
Go ahead, Well, every plan would have an appealed process,
and they should make that evident to the policyholder, you know,
just calling customer service for example, So how do I
appeel that? And the industry numbers show that claims that
are appealed roughly half of them are paid and in
(05:38):
part or in whole. So reading actually in part or
in whole. It could be that a claim was denied
because there were several things in there that aren't covered,
and even if they paid for the balance of the claim,
the ones that aren't covered are considered in denial. So
that goes into statistics, you know, appeals for Yeah, as
(06:01):
you said, yes, you.
Speaker 3 (06:01):
Know, this is a troubling time for a lot of
Americans because of the cost of health care and the
cost of insurance, and it's a very complex financial equation.
But at this point in time, this is the kind
of thing that drives momentum for a single payer system
that is quite frankly, very popular around the world. In
(06:24):
your view, what is the current state of health insurance
in this country and what do you see five to
ten years from now.
Speaker 2 (06:32):
Well, I don't know what will happen five to ten
years from now. I think I prefer the program we
have now because I've been in a lot of countries
that have a socialized program and single payer style health insurance.
But name in the country, and I'll tell you why
(06:53):
I am concerned about that sort of a program. Many
many will have a a payer plan. But you can
still go outside the system, like uh, great Britain, you could.
You can. A lot of people call it insurance that
jump the queue because uh, you know, you get in
a waiting line to get your healthcare and and uh
(07:17):
but if you're if you're a cash payer, you can
get ahead of the line. You can go to a doctor.
That looks up.
Speaker 1 (07:21):
But is that affordable? What that would that system work?
Is that affordable?
Speaker 2 (07:27):
Well, the taxes are a lot higher.
Speaker 1 (07:29):
Yeah, But I mean if you jump the line, what's
the cost for that? I guess there's the question in
other words, that you have to be loaded in order
in order to afford that to jump the line.
Speaker 2 (07:41):
Yeah, if you're going to pay yourself, it's it's uh
uh quite expensive. But if you buy private insurance to
jump the queue, uh, you know, that's that's reasonable. I'm
you know, I I I have family in Guatemala and
they have a single payer system. Except it Isn't you know?
(08:04):
You buy insurance to go to a different facility, a
private facility, and get a different style of care, and
you get it immediately.
Speaker 1 (08:14):
M lots there. I wish we had a longer discussion,
but I appreciate your input. Always art our Jetter one
of the great insurance executives I say that seriously in
this country and the official evil insurance man. Okay, Baby's
born
In the wake of the murder of United Healthcare CEO
Brian Thompson. The insurance industry in general has been under
the microscope and has taken a lot of fire, and
there are so many issues here that it's complicated to
try to to do justice to it in a relatively
(00:22):
short segment. But if anybody can, it is our official
evil insurance man of kfab's Morning News, Art Jedter of
the Art Jeter Company, longtime insurance executive.
Speaker 2 (00:32):
Our good morning, Good morning Gary.
Speaker 1 (00:34):
Great to have you here. Is there a generalized or
thumbnail version of the insurance industry response to the criticisms
that have been raised in the wake of this murder.
Speaker 2 (00:49):
I don't know if I speak for the entire industry,
but I think I hope we can agree that there's
absolutely no justification for murder people who makes a statement
or the selves or themselves creating a problem. I just
ask if they were able to look in the heart
of the victim or they just make an omption. I've
met many CEOs over my years in the business, and
(01:12):
I've heard more than one say something like, my objective
is to provide more value to our policyholders. So I
think it's a very sad state of affairs when people
try and justify this sort.
Speaker 1 (01:26):
Now there's no question about it. And the sad fact is,
of course that we can't all agree that the murder
wasn't justified. I would hope that in this contry there's
an overwhelming majority of people that would agree to that.
You know, one of the things that and Art and
I have chatted about this before. One of the things
that gets lost. And I'm not going to claim to
(01:49):
be an expert in anything, and I'm not saying the
insurance industry is blameless, but you never hear you certainly
don't hear it in this case about they provide the hospitals,
the medical associations, the doctors and so forth, and the
costs that you see on your bill when you have
some kind of medical procedure or inpatient visit or whatever.
(02:14):
It is enormously expensive. That parton never guess mentioned, ark No,
But we all want.
Speaker 2 (02:22):
Our health insurance companies to our health and insurance plans
to pay for pay for our costs or for our
healthcare costs. It's the lowest possible cost to us, the
lowest premiums, and we don't want our premium to be
any higher than necessary. But I would like to say,
you know, we've heard about the denial rates of claims.
I looked into that particular company and their denial rate
(02:47):
is not as high as being reported. And what's interesting
is they pay eighty percent of their claims when submitted
eighty seven percent, and of the remaining thirteen percent, only
one percenter denied due to clinical reasons, the other the
other twelve percenter due to administrative errors or missing information
(03:08):
or duplicates or non covered services. And you know, I've
been asked more than once what's a non covered service?
So I'll give you an example. Medicare pays one hundred
percent for twenty days of skilled care at a facility
when it's rehabilitating. But that that often gives people the
idea that Medicare will pay for custodial care in a
(03:30):
facility when the time comes when someone can no longer
dress or feed themselves, that sort of thing. But Medicare
pays for skilled rehabilitating care and does not pay for
custodial care, so those claims come in that would be
an example of a non covered service. I just say
that if you want insurance, it pays for long term
custodial carry, you need to buy long term care insurance nets.
(03:55):
But that would be an example of a non covered
expense that I notice. Go ahead here, Well, I know
this is basic logic, but the cost of insurance is
directly directly related to the costs pay for care, just
like you were saying. And so people who buy insurance,
(04:16):
who pay for insurance don't want their insurance plan to
pay for things that aren't supposed to be covered, and
so there has to be some sort of review process.
We don't want our health insurance to be subjected to
scams or fraud or waste or abuse. And when insurance
plans find those they just if they don't catch them,
(04:38):
it just drives up all of our premiums. So everyone
should want a process where those kinds of things are challenged.
Insurance companies are the ones that catch those scams and
waste and abuse.
Speaker 1 (04:53):
Is there anything? A lot of people and part of
the literature I've read is that, yeah, if you have
a claim denied and you believe it's legitimate, you should
appeal it and make your case. A lot a lot
of people are difficulty navigating that. Is there?
Speaker 2 (05:13):
Go ahead, Well, every plan would have an appealed process,
and they should make that evident to the policyholder, you know,
just calling customer service for example, So how do I
appeel that? And the industry numbers show that claims that
are appealed roughly half of them are paid and in
(05:38):
part or in whole. So reading actually in part or
in whole. It could be that a claim was denied
because there were several things in there that aren't covered,
and even if they paid for the balance of the claim,
the ones that aren't covered are considered in denial. So
that goes into statistics, you know, appeals for Yeah, as
(06:01):
you said, yes, you.
Speaker 3 (06:01):
Know, this is a troubling time for a lot of
Americans because of the cost of health care and the
cost of insurance, and it's a very complex financial equation.
But at this point in time, this is the kind
of thing that drives momentum for a single payer system
that is quite frankly, very popular around the world. In
(06:24):
your view, what is the current state of health insurance
in this country and what do you see five to
ten years from now.
Speaker 2 (06:32):
Well, I don't know what will happen five to ten
years from now. I think I prefer the program we
have now because I've been in a lot of countries
that have a socialized program and single payer style health insurance.
But name in the country, and I'll tell you why
(06:53):
I am concerned about that sort of a program. Many
many will have a a payer plan. But you can
still go outside the system, like uh, great Britain, you could.
You can. A lot of people call it insurance that
jump the queue because uh, you know, you get in
a waiting line to get your healthcare and and uh
(07:17):
but if you're if you're a cash payer, you can
get ahead of the line. You can go to a doctor.
That looks up.
Speaker 1 (07:21):
But is that affordable? What that would that system work?
Is that affordable?
Speaker 2 (07:27):
Well, the taxes are a lot higher.
Speaker 1 (07:29):
Yeah, But I mean if you jump the line, what's
the cost for that? I guess there's the question in
other words, that you have to be loaded in order
in order to afford that to jump the line.
Speaker 2 (07:41):
Yeah, if you're going to pay yourself, it's it's uh
uh quite expensive. But if you buy private insurance to
jump the queue, uh, you know, that's that's reasonable. I'm
you know, I I I have family in Guatemala and
they have a single payer system. Except it Isn't you know?
(08:04):
You buy insurance to go to a different facility, a
private facility, and get a different style of care, and
you get it immediately.
Speaker 1 (08:14):
M lots there. I wish we had a longer discussion,
but I appreciate your input. Always art our Jetter one
of the great insurance executives I say that seriously in
this country and the official evil insurance man. Okay, Baby's
born
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.