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That may be the way you justify it as somebody inside the industry. Caregivers say the cost of care goes up because of how insurance handles claims. So, who do you listen to? I can tell you from the outside that the whole thing is like betting against the house. The house will fuck you any way it can. Occasionally you get a comped dinner or something, but only so the money keeps coming out of your pocket and into theirs.[/QUOTE]
It's not the way I justify it, thats the way it is. The majority of my business comes from groups in the healthcare field(hospitals, nursing homes etc.) As far as hospitals go, they have to do a certain number of tests in order to cover their backsides from malpractice suits, in which case insurance companies will not pay for blatenly unneccessary tests. That is the ONLY time your insurance company will deny payment, or if you went to see a specialist without a referral from you PCP, which is stated in plain english in your policy. If your insurance company doesn't pay a claim it is most likely your own fault for not following the terms of the policy, but most times the insurance company will work with you or give you the benefit of the doubt. I know the company I work for does it all the time...someone has an accident that is not covered on their supplemental plan but a phone call to me from the insured then a phone call from me to my company will 90% of the time get them paid.
My point is people need to read their policies and stick to the guidelines, if they don't understand I guarantee you a quick phone call to their agent or to customer service will clear up any misunderstandings
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