If no one ever got sick and never needed to file a claim, they would
have a much more friendly health insurance company. In reality however,
they spend an excessive amount of time and resources discounting or flat
out denying claims. No one expects every claim to be paid without
question, that may or may not result in the company going out of
business.
If no one ever got sick and never needed to file a claim, they would have a much more friendly health insurance company. In reality however, they spend an excessive amount of time and resources discounting or flat out denying claims. No one expects every claim to be paid without question, that may or may not result in the company going out of business.
When it comes to health insurance companies they think that they are saving themselves money by denying claims when in actuality in many cases they are spending quite a bit to keep fending off angry patients and in the end they must pay for some type of treatment. Treatment plans should be developed and implemented between the patient and the doctor and the health insurance company should have little say in whether or not you are allowed to have a specific treatment administered.
This is becoming a huge battle for many doctors who admit it is much easier to stay away from some types of treatments and pick a treatment they know will not cause any major conflicts with the insurance company, regardless of the terms of the policy. Many ill patients are quickly learning the whole process can cause them to submit to the decision of the insurance company without much of a fight.
In the usual course of things, the doctor will prescribe what they believe will be the best treatment, only to have their recommendations denied by the insurance company, however you do have some options to choose from at this point. Filing a complaint and have it reviewed is one. You can also, according to the new health care laws have the denial reviewed by an independent evaluator. You do have a right to defend the doctors decision over the insurance company decision and request the claim denial reviewed.
If the health insurance company continues to deny your claim you can still continue to fight it further but in the interim you will probably have to decide whether to have the treatment done and pay out of pocket for it or to try another treatment option that your health insurance company approves of. While this may not be the way you wish to handle it, you may only have a limited about of time to spend wrestling with the health insurance company. Your treatment is more important than anything else and delaying it may not be in your best interest.
