The difference between health care, insurance

Merriam-Webster defines health care as “efforts made to maintain or restore health especially by trained and licensed professionals” and defines health insurance as “insurance against loss through illness of the insured; especially insurance providing compensation for medical expenses.” My purpose in identifying this distinction is to help Mr. Christians (Jan. 5, 2017) and many others, understand the difference between health care and health insurance.

Mr. Christians’ concerns seem to center around the type and variety of insurance plans available to his family. He stated that there are “only two forms of health care available, Blue Cross or Blue Shield.” Neither Blue Cross nor Blue Shield is a provider of health care.

Individuals voluntarily contract with one or more companies to assist with the expenses related to their care. Having health insurance is not required in order to access health care although; it is usually a smart financial decision to have health insurance or allocated resources in place to assist with these financial burdens.

Mr. Christians is correct in that health care providers spend a great deal of time and expense processing insurance claims for their patients.

Additionally, we spend many hours working to obtain and maintain credentials with insurance companies in order to remain on their provider list. There is no negotiation of fees with most companies as they simply inform us what they are willing to pay.

We have found that most consumers of health care have very limited understanding of their policy, coverage and financial responsibility. We attempt to gather that information for our patients and spend a great deal of time educating them on their benefit coverage however in many cases; patients will become frustrated with us over the terms of their plan.

It is important to remember that it is your responsibility to understand your insurance information. We will process your insurance claim for you as a courtesy but you are ultimately responsible for your medical expenses, not your health insurer.

I understand how confused and frustrated our patients become when they do not understand their coverage or they are disappointed when it isn’t what they expected it to be. Especially now when so much has changed and is changing. We in health care would appreciate your patience and courtesy, and as they say, please do not shoot the messenger.

“The Healthcare Openness and Access Project measures how open and accessible each state’s healthcare system is to patient and provider preferences”. I believe this study looked at the state of Idaho as a whole in determining their results.

Certain areas are more comprehensively covered than others. Rural areas of Idaho are served by fewer providers per capita than more urban areas but collectively, the study finds access to health care in Idaho to be excellent. I would highly recommend a thorough review of the categories measured in the study. It is quite interesting.

(Mr. Christians, I have heard that Kaniksu Health Services is accepting new patients as are many of the nurse practitioners.)

Kris Sabo, R.N.

Executive Director

Pend Oreille Surgery Center, LLC