providers

The Match Game of Healthcare That Works: Understanding Insurance

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Understand What Insurance Is and Is Not

Finding healthcare resources – people, treatments, care – is a match game. Your quest is to find resources to partner with you to feel better, heal and experience the life you want to live.

Reading “match game,” the vision that probably came to mind involves perusing a list of “providers” your insurance company included in a thick volume of paperwork. Or maybe you wish you at least had an opportunity to have access to such a list. You see lists organized by “specialty” (which you may or may not understand) and geography; and you hope you can find someone with solutions for your needs – someone to help you feel better – from this paltry information.

The Traditional Match Game: The Insurance Company Sets the Playing Field For “Health”

Health insurance is not healthcare. Insurance is business. Health insurance is a payment system.

In the framework of the traditional match game, the insurance company sets the rules with four basic things: 1) a list of “providers” – people who meet the company’s contractual requirements; 2) a list of acceptable services (your “benefits”) the providers can offer for certain ailments; 3) acceptable fees for such services; and finally 4) a means to parse the payment/cost burden. This is so familiar that perhaps we didn’t even question this until prices sky rocketed and services diminished.

Playing the well-being match game within this familiar framework puts the insurance corporation in a position of power. Playing the match game this way immediately puts a corporation, a payment system, in control of your well-being. Through their contractual relationships they determine what constitutes health, who is allowed to serve your needs, and what treatments or medications are acceptable. Insurance companies narrow the field of possibilities and choices for your path to well-being.

By engaging in this match game we’ve been attempting to attain well-being from a system in which the rules have been set by companies that are focused on payment and profit. Pause and think about that for a moment. We have been lulled into looking to a payment system as a means to experience vitality.

You may have had very good success with this structure. While this may work well for some, and may work some times; for many it is a challenge to find care that works. That challenge can take a further toll on health.

In this traditional match game it is very difficult to insert your personal needs, values, and beliefs about health and well-being into the framework of a payment system. It can be a challenge to find the right partner in healing, the right practitioner, who supports your personal journey to live your best life.

Time To Shift the Paradigm

If it doesn’t work for many, if not most, people to look to a payment system as a means to experience well-being, what do we do? It requires a change in the fundamental nature of the match game. In the next article we’ll explore this shift. It begins with identifying your personal concept of the essence of health, well-being and healing. This will vary for each person, and can vary over time. This shift puts each person back into control of their health.

About the author: Deb is co-owner of Experience In Motion, which equips organizations with tools to curate meaningful experiences for customers and employees. Deb’s personal journey from decay to well-being inspired an emphasis in improving healthcare experiences for patients and practitioners by focusing on experiences that heal and self-caring as a way of organizational being. www.experienceinmotion.net.

Note: This is part of an ongoing series to equip you with a process, a path, to identify and experience healthcare that works for you. Other articles in this series are:

The heart of healthcare that works: know your personal worldview of health   

Find your Inner Chris Columbus

The Heart of Healthcare that Works: Know Your Personal Worldview Of Health

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Healthcare Matters

“All the evidence that we have indicates that it is reasonable to assume in practically every human being, and certainly in almost every newborn baby, that there is an active will toward health, an impulse towards growth, or towards the actualization.”
–  Abraham Maslow

Google “healthcare” and it returns 99,900,000 results. Healthcare seems to be a vast, complex, inconsistent, and perhaps unavailable or expensive system ‒ sometimes seemingly devoid of personal connection.  At a minimum, it can be confusing to find what will work for you.  Really work for you, on all levels.

Here’s the good news:  when you define healthcare for yourself, the path towards growth and actualization Maslow speaks of becomes easier to find and follow.  Forget what healthcare is for your best friend, your family, or a generic patient with similar symptoms you read about online.  Forget about some list in your health insurance policy.   That’s just a list based on contractual relationships, which may or may not relate to what works best for you.

Healthcare is deeply, deeply personal.  Only you know what healthcare is for you. It depends on your values, your beliefs, your worldview.  And, those can change over time.

Finding healthcare that works for you is a bit like going on a quest – an adventurous exploration.  You have to know what you’re seeking, the signposts to know you’re on the right path, and some friendly support along the way (wisdom, people, or places) helps too.

To narrow the vast landscape of healthcare to what will work for you, begin by understanding, or perhaps taking this opportunity to create, your personal worldview of health, healing, and well-being.  If your choice of physicians, practices and medicines doesn’t resonate with your worldview, there will be discord.  Discord, at a minimum, makes communication with practitioners challenging.  In some medical sciences this discord would be believed to have a negative impact on healing at a very deep level.  Knowing your worldview gives you a foundation for harmonious choices.

To explore your worldview, some questions to ask yourself include:

• Do you believe health is based on primarily how each part of the physical body separately functions?
• Do you believe the mind can influence the physical body?
• Do you believe there is an interrelationship between mind, body and spirit; a holistic view of your being?
• Do you believe the body is basically like a machine (also identified as a Newtonian view of the world); and should be treated in a mechanical nature?
• Do you believe your choices – from the food you eat, to your relationships (including work), to the surroundings you live in – influence your well-being?
• Do you believe in a “one solution fits most” medicine; or that each person is unique and therefore may require varying paths to well-being, even if the diagnosis or symptoms are similar?
• Do you believe in treating the illness or the person with an illness?
• Do you believe in focusing on the disease (diagnosis, symptoms); or on health and well-being?
• Do you believe in healing, curing, pacifying symptoms, or something else?  Or all of those in different situations?
• Do you generally believe in an interconnected world?  Or a world where all beings and things are separate?

Answering these types of questions will significantly narrow the landscape of your quest – narrow down what will work for you. No one can answer these for you.  You may want to write a personal worldview statement to crystallize your worldview.

Equipped with your personal worldview of health you can then move on to the next steps in your quest:

• Identify what health, well-being and healing mean to you
• Know what qualities of care are important to you
• Understand what “medicines” resonate with you

In the coming articles we’ll delve into each of those areas with more questions to help you find healthcare that works for you.