Insurance Issues That Must Be Discussed
June 19, 2008
There are over 47 million uninsured American citizens and that too when the US spends twice more than any other rich country on per person health care. The health care outcomes for those who are insured are also nothing to brag about.
The enormous discrepancy in the US Insurance System is said to be the root cause of the problem. Countless insured citizens encounter difficulties in trying to get a reimbursement for their medical bills. More often than not they end up paying the bills themselves. The insurance agencies keep making the common man run around trying to fill up the innumerable forms only to be denied reimbursement in the end. No explanation is offered by the agency for its refusal to reimburse and people are left with no option but to accept the verdict or waste precious time trying.
The insurance agencies are supported in this by the law of the land which does not issue any penalties or fines on them for wrongly refusing the claims.Also, insurers are not required to reveal the criteria on which they deny the claim and are even exempt from confessing how many times they deny the claims made. In such a bleak situation, how is the ignorant citizen going to choose the right insurance agency?
Apart from the above mentioned information that is denied to citizens, there are even more critical issues that are kept in the dark by the agencies. For example, for people who go “out of network”, the amount reimbursed by the insurers is 70 to 80% of their “reasonable and customary” rate. Of course the insurer does not tell the claimant in advance what the “reasonable and customary” rate is. So patients are clueless about how much a visit to the local doctor will cost them till the doctor files a claim.
