Health Insurance Companies - Their Abuse And Tricks, Part One

There is small or no uncertainty that the Health Insurance Industry have a strangle clasp on docs and other healthcare suppliers and the bringing of healthcare. There may be small hope as a important figure of these wellness coverage companies acquire richer and richer; their edifices acquire taller and taller and they go more than powerful political lobbyists. CEOs may command six or even seven figure salaries. In a important figure of cases, bonuses turn and boom as life-saving or wellness preserving medical specialties and attention are denied. This series of articles will concentrate on the maltreatment inflicted on healthcare suppliers and the healthcare system by a important figure of wellness Insurance companies. "The nation's HMOs reported a $3.6 billion net income for the first three calendar months of 2005, representing a $646 million, or 21.4 percent, addition over the $3.0 billion earned during the first one-fourth of 2004" according to Weiss Ratings, Inc.

Abuse #1: Pre-existing Condition.

Patient walks into a doctor's business office to be seen and he or she shows his or her wellness coverage card. The staff verifies coverage coverage and / Oregon obtains a valid referral (permission) from the insurance company to see the patient. The patient is seen to take of the concerning wellness problem. The coverage company is billed. The doctor's claim for payment is denied. Pre-existing condition is the ground given by the coverage company. In other words this status started before (pre-existed) the insurance coverage. However, a physician cannot cognize this unless he or she first sees the patient and takes a history. The physician or other healthcare supplier may never acquire payment. The patient despite paying insurance premiums may acquire stuck with the bill. The coverage company pockets this money. The fighting is on. Guess who usually wins, the company in that 20 or 40 narrative lavish corporate business office edifice that have enough reddish tape to bind up the healthcare supplier for calendar months to come. Guess who usually gives up.

Example: I was asked to confer with on a hospitalized patient because she was passing blood and in hurting owed to a kidney stone. Imagine my surprise when my claim for payment was denied for pre-existing condition. The coverage company claimed that the rock was pre-existing!

Abuse #2: Referral or Prior Authorization

It is my sentiment that the pattern of coverage companies mandating that healthcare suppliers acquire particular permission (referrals or anterior authorizations) should be banned. These referrals or anterior mandates may be imposed on a healthcare supplier before he or she can give a patient a wellness preserving medicine, diagnostic test, hospitalization or even an business office visit. Referrals or anterior mandates in too many lawsuits hold attention and may put a patient's wellness in jeopardy. They are barriers to attention and in many lawsuits are used as arms to deny care in order to line the pockets of the coverage company. Isn't it silly to believe that healthcare suppliers who have got spent many old age in preparation and are indeed experts can’t find on their ain if a patient necessitates to be seen or is in demand of a medical specialty or test.

Example: A patient presented to my business office just after closing. I had seen her in audience in the past for uncontrolled high blood pressure. She was not feeling well and she complained that her blood pressure level was elevated. The coverage company was closed so we could not acquire a referral number. I obviously saw the patient and administered medical specialty to cut down her blood pressure. She felt better. I also prevented a needless exigency room visit. The adjacent twenty-four hours we called the coverage company to explicate our state of affairs and they said they would deny our claim since we saw her without permission.

Healthcare suppliers and patients must talk up and demand that our elective functionaries do wellness coverage industry reform a priority.