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Opportunities and Challenges faced under the Umbrella of Insurance
Opportunities and Challenges faced under the Umbrella of InsuranceKathy Gibson Boatman I sold insurance from 1994-2000 and I had an opportunity to learn how the products work and some of the challenges that insurance is incapable of handling. Like most people, I didn’t grow up saying….I want to be an insurance agent. An opportunity for a good job with a respectable company presented itself and I took it. Due to this opportunity I was able to learn about insurance and that experience has proved itself to be more valuable than I ever imagined it could be. While I was an insurance agent I took classes and learned the art of sales. I learned basic facts about the financial world that benefit me to this day. I learned how to read and interpret a contract. I learned what a fiduciary responsibility is. As defined in Wikipedia it means: A fiduciary duty is a legal or ethical relationship of confidence or trust between two or more parties, most commonly a fiduciary or trustee and a principal or beneficiary. As in insurance agent I had a fiduciary responsibility to my client and to the insurance company. It isn’t something that sounds exciting but insurance is not exciting to most people. As an insurance agent I came to appreciate the security of an insurance policy that could protect my future and the future of my family in uncertain times and when the unexpected disaster strikes. I learned about products that protect families, businesses and individuals in the event of fire, accidents, theft, sickness, litigation and death. I also learned about exclusions, things that are not covered and special conditions that apply under certain circumstances. I learned about deductibles, the portion of the loss that is to be “shared” by the insured party and the company providing the coverage. I learned about coverage available and in some cases mandatory for uninsured and underinsured claims. While the topic of insurance may not seem exciting and may be downright boring in some situations, it is relevant to a number of events that I have faced in my life. Many American citizens have faced similar challenges, some with the benefit of insurance and some without. I can start with the more ordinary incidents like car accidents and damage to vehicles that most people have experienced. Most people have a good understanding of this type of situation, so we won’t waste energy on that topic. We can discuss the more unusual situation like when my parent’s home burned in a forest fire and we were able to start rebuilding due to their insurance benefits. We were thankful for the insurance that was available at the time even though it fell short in replacing what they lost. We can examine the challenges that I faced when a personal health crisis and illness came along. Insurance helped my family pay unexpected medical bills and helped me access excellent medical care. Even though it didn’t pay for everything, it was certainly of value at the time and I was thankful it was available. We can laugh now about my ex-husbands weird motorcycle accidents that left him disabled for a period of time. We certainly weren’t laughing about it then. We were thankful for the disability policy that helped put food on the table and the health insurance that paid the medical bills for the surgeries that were required to put him back together. We can cry and look at each other with shock and dismay as I relate the horror of my son’s suicide attempt and the callous way his insurance denied coverage when we were right in the middle of the catastrophe. You see, self inflicted injuries are one of those exclusions that I mentioned earlier. The story has relevance to the current insurance debate about government provided health insurance because even though coverage was denied at the time, the government stepped up and he was able to qualify for AHCCS coverage and he continued to receive the medical care he so desperately needed at the time. The AHCCS coverage didn’t provide for all the care that he needed at the time, but it did give us a resource when we thought all hope was lost. The private health insurance company later reversed their denial when they determined that my son’s suicide attempt was due to a “mental health illness.” It seemed unfathomable at the time, how could anyone shoot himself in the face with a 12 gauge shotgun if they weren’t suffering from a mental illness of some sort? His private insurance policy included “mental health benefits” at the time of the accident. For a period of time I thought the government provided AHCCS policy would create more problems than it had solved because when the private insurance came back into play, after reversing their denial, I thought the AHCCS policy was going to give the private insurance a way out of covering the accident. As it turned out, the two policies worked in conjunction to pay for most of his medical expenses. My son was off work for over two years while going through a facial reconstruction process. During this time I helped him apply for the government provided social security disability coverage. He had paid into the system since he was 16 and he was clearly disabled, he had one surgery after another and was unable to work due to the situation. Social Security declined his request for disability coverage 3 times. We finally resorted to hiring an attorney and several years later he won his case and was awarded…..about $11,000.00. While we were thankful that the social security benefit did eventually come through, we went through a great deal of stress and financial difficulty that could have been vastly improved with money being provided during the time it was needed most while he was actually unable to work. Not to mention the fact that the attorney got a large portion of that money and while we valued her service, Dirk needed the money more than she did. Another example of how the private insurance did more than the government coverage is that AHCCS does not cover the replacement of teeth in this situation. Private insurance hasn’t covered everything but it has done a better job of taking care of my son than the government has and it has covered most of the costs associated with his dental implants. During this event I have had to rely on the living benefits provided by my life insurance. People may wonder, what are living benefits? Well, living benefits are the benefits that can be accessed while a person is still alive. You see, I purchased whole life insurance for both myself and my son. Whole life insurance develops cash value over time and as a policy owner you can take a loan against the value of the policy. I have had to resort to these loans on numerous occasions when the government had no benefit to offer at all. Another unexpected value we have from the private insurance that we purchased is that Dirk has life insurance now due to that purchase being made when he was just a young boy. Most insurance companies will not provide life insurance for someone who has attempted suicide. I believe the point of this story is that while private insurance doesn’t solve every problem and it has its limitations it certainly has done more to help my family than government insurance has. I prefer to rely on a system that has been around for years and it is definitely better than the alternative being proposed by the current administration. I would rather work to access coverage as defined by a contract in the “free market” than to fight an all powerful government agency. I have experienced both sides of this and I do know what I am talking about as illustrated by my story. Questions I have for the current administration regarding the proposed changes to the health insurance industry include but are not limited to the following: Why do we carry “uninsured motorist” coverage if everyone is “required” by law to have insurance? The short answer is, because not everyone does carry that “legally required insurance” and we still have to protect ourselves from that risk, at our own expense. I believe the same situation will occur if the government requires everyone to purchase health insurance. There will be those people who don’t follow the law and the rest of us will still pay for their lack of participation. Our elected representatives have a fiduciary duty to us, but it does not mean that they honor that duty. Why should I believe that they have my best interests in mind now? They have illustrated their contempt for that fiduciary duty and even if they are supposed to be ethical in their decisions and actions, do they illustrate an ethical relationship with their constituents? Kathy Gibson Boatmanwww.acowgirlsview.com.