The main intention of taking a medical cover with an insurance company is to guarantee minimal pay incase one is hospitalized. This however is turning out to be not the case this is due to the high profit centeredness that the insurance companies are portraying
When one is taking an insurance cover he is required to disclose every material information to the company, this should also be a matter of ethics for the insurance companies to disclose the same to its clients, more to this any extra financial benefit that a client may receive from an insurance company is treated as unjustified and should be surrendered this then should be the case with the insurance firms to share the gains (Discounts) that they do receive with their clients
(Francis & Michele, 2008)
In our case regarding to Gerald and Trigon blue cross/blue shield two unethical institutions arise that is the insurance company and the government.
First the government should ensure that all of its citizens are subjected to affordable and high quality healthcare therefore legislative laws should be set to ensure that health of its citizens is not kept at risk by selfish insurance firms in doing so citizens’ productivity will be promoted thus increasing economic growth (Martin, 1998).
Insurance firms should also be ethical enough to disclose all the terms of the insurance cover to their clients like not to pretend that their sole role is to offer safety and guarantee of quality and affordable healthcare while in real sense they are enriching themselves.
Insurance companies actually should be offering incentives to encourage more people to take up medical cover with them but in real sense this is not the case, they are actually discouraging people from doing so and taking advantage of the innocent ones who take policies with them.
Unethical actions are further shown when employer’s claim that discounts provided should not be disclosed to the employees this directly shows that there are selfish gains that do exist to employers.
It’s also unethical for insurance companies to establish themselves with intentions of enriching themselves from finances obtained from their clients using illegal means.
Ethical morality is also seen to be upside down because the role of insurance firms should be to indemnify its clients but we end up seeing that what they are actually doing is siphoning money from their clients.
Insurance cover is seen as transferring risk burden to another party for but according to this case it actually becomes the actual risk retention since one ends up bearing higher costs which he thought he had transferred.
Acting as ultimate authority I would ensure that any discount offered to the insurance firms should be shared equally with their clients. I would also ensure that its mandatory for any discount offered to be communicated to the client to decide whether that benefit should be used to reduce their premiums or the coinsurance payment (Robert, 2005).
Also I would threaten to withdraw trading licenses for those insurance firms that will not be ready to share the discounts received equally with their clients.
I would see to it that notices are provided to patients discharged for them to see the amount of discount that they have been provided this would ensure that insurance firms do not sideline them claiming that no such discounts were provided to them.
Francis, M. and Michele. (2008). Bowsteads and Reynolds on Agency. New York: Sweet and Maxwell publishers.
Robert, F. (2005). Broker to Broker. California: wiley-interscience publishers.
Martin, R. (1998).The Economist. New York: Sweet and Maxwell publishers