Health Insurance Advocacy Background
Why is health insurance such a hot topic?
It's a hot topic because there are so many people who are denied claims and who die because of it. Unlike any other service that we purchase or use, health insurance, if it doesn't work right, your life could depend on it.
How have insurance industry changes contributed to the current situation?
In the last twenty years, the health insurance industry has changed the way that they look at doctors' opinions, and at the payment system. The increasing costs of health care have caused them to restrict care as much as they can, and take on each individual person who may be dying and not have the will to fight them, and try to reduce the amount they pay out. So there has been a change in the way that they pay, the way that they review, and the way that they accept doctors' opinions, in order to save money.
How does health insurance work?
How do health insurance companies impact medical decisions?
Since medical insurance companies are run by Wall Street entities, they general put profit and money over people and medicine. So they are going to stand between you and the doctor to try to limit the care or make it the cheapest possible care possible for you before you go get it or deny you, delay you and keep you from getting that care.
How do health insurance companies determine what to cover?
They will generally look at what your doctor has recommended. Usually, they're going to cover anything that is cheap, anything that is new that is high tech, and they're going to try to eliminate as much as they can. Unfortunately those are sometimes the things that may prolong your life or save your life if you should have cancer, or if you have a rare disease and need one of those procedures.
Who regulates the health insurance industry?
There are state regulators and there are also federal regulators of the insurance care industry. Even within that regulation, there are terms that they pick and choose with their groups of lawyers to put into your contract. They give you that contract, and you can't negotiate it. When you're ill, when you're fighting for your life, they can choose to define a term in any way they want, and they will usually choose to define that term in a way that may not give you what your doctor is saying you need. There are state and federal regulators that oversee, in general terms, the health care industry. There are places that a consumer can make a complaint to, and on small items, often they'll follow through and make sure that they help you. Often, when your life depends on it, and you need a $300,000.00 procedure, you do have to seek out professional help in the form of a lawyer.
