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Consumer Rights and Insurance
I have been reading posts about insurance companies not paying for this or that. Remember, that is their only product- the ability to pay or not. They are nothing more than risk brokers. If you viewed them as a local grocery store, they would be one that sold only one product- lottery tickets. Except in this game, the insurance execs get the money and the patients get sicker.
In dealing with insurance companies do the following:
1. Call to get a name of a supervisor AND the medical director
2. Do not try to speak to that person unless you like being on hold for hours
3. Write a letter to them. Be sure to include the nature of the problem and the solution you recommend.
4. If THAT person does not respond to you in 3 weeks then write another letter
5. In this letter, reproduce the firsts letter but this time send a copy to the following bodies:
a. The State Insurance Department (they are all online- Google your own State- complaints can be online,
b. The Office of Professional Medical C0nduct (everey State has one)- complain specifically about the Medical Director. While our archaic laws prevent us from suing these "doctors" for malpractice, they do have professional licenses and their behavior in the interests of the insurance companies actually violates many of these ethics. The OPMC by law must investigate and if found in violation they will yank the license of the medical director. THIS IS MY ABSOLUTE FAVORITE ATTACK STRATEGY!
Fight back. Do it all in writing. The people you speak to on the phone are hired robots.
Related Topics: Getting the Care You Need, The Cost of Pain
Technorati Tags: claims, consumer rights, health insurance
In dealing with insurance companies do the following:
1. Call to get a name of a supervisor AND the medical director
2. Do not try to speak to that person unless you like being on hold for hours
3. Write a letter to them. Be sure to include the nature of the problem and the solution you recommend.
4. If THAT person does not respond to you in 3 weeks then write another letter
5. In this letter, reproduce the firsts letter but this time send a copy to the following bodies:
a. The State Insurance Department (they are all online- Google your own State- complaints can be online,
b. The Office of Professional Medical C0nduct (everey State has one)- complain specifically about the Medical Director. While our archaic laws prevent us from suing these "doctors" for malpractice, they do have professional licenses and their behavior in the interests of the insurance companies actually violates many of these ethics. The OPMC by law must investigate and if found in violation they will yank the license of the medical director. THIS IS MY ABSOLUTE FAVORITE ATTACK STRATEGY!
Fight back. Do it all in writing. The people you speak to on the phone are hired robots.
Related Topics: Getting the Care You Need, The Cost of Pain
Technorati Tags: claims, consumer rights, health insurance
13 Comments:
Thank you for posting this! You've put it very succinctly, and it's information patients need.
I work as an insurance specialist for a private surgical practice, and there are many cases when we (as the physician) CAN'T appeal, the patient must do so. I'm going to save this for reference, with your permission.
Again, thank you.
In New Jersey, it's the State dept. of Banking and Insurance that regulates health insurers. They were able to tell me that it's my right to have a paper copy of my individual health ins. contract. After 3 unsuccessful attempts to get a copy, all it took was a brief phone conversation with a supervisor at the insurer's tollfree number, in which I told her I was about to file a complaint with the state agency, to get her to FedEx the contract to me. She sounded apologetic, and scared that I would go down that complaint path. I have to add, it took some time to get to the right person at the state agency, who could advise me of my rights.
You make me think of Robin of Sherwood, Dr K.
As an anonymous medical blogger, to openly stand up to those exploiting patient welfare for corporate gain...you're actually quite an inspiration.
I have recommended you on my own fledgling site, hope you don't mind :)
Thank you! I've been looking for something to try to use to set things right so other people do not go through the pain and suffering my mother did. I shall certainly try this!
Judy
gag@judyanddan.com
Thank you for the comments:
The key is to fire the first shot. Do not threaten to report the insurer to the Department of Health- DO IT. E+Right from the start. As soon as you get the inkling of resistance complain in writing across the board.
Are options like this:
http://www.medicaldiscountbenefits.com
a legitimate option for people like me who don't have insurance (yet)?
In general these are a scam. You get a "discount" on certain things and not a subsitute for insurance. Save your money.
I understand everyone wanting the insurance companies to provide everything.... but don't you know what they will and wont provide for prior to buying their product... to me it is like buying a car without airbags then complaining the bags never deployed when you got into an accident... I know my insurance provider won't do everything I would like, but it is better than no insurance at all...
Thank you, doctor, for the suggestions. I am a veteran of over 3 years of battling insurance companies, starting with a liver transplant. My rare hereditary disease led to over $1M in claims...and to at least 500 person hours of correcting errors, hectoring companies to pay money due, and defending against false denials of claims (the default action at most insurance companies). The problem is, of course, that you are sick, recuperating, and not in full fighting trim. That is the virtue of the suggestions you make, to increase the efficiency of those who are fighting for their lives.
Sincere thanks,
Another ClaimantWarrior
Thank you, doctor, for the suggestions. I am a veteran of over 3 years of battling insurance companies, starting with a liver transplant. My rare hereditary disease led to over $1M in claims...and to at least 500 person hours of correcting errors, hectoring companies to pay money due, and defending against false denials of claims (the default action at most insurance companies). The problem is, of course, that you are sick, recuperating, and not in full fighting trim. That is the virtue of the suggestions you make, to increase the efficiency of those who are fighting for their lives.
Sincere thanks,
Another ClaimantWarrior
Thank you for your post. Anyone having problems should have their written HMO's guidelines for whatever service they are looking for. The HMO is legally bound to it and you are legally entitled to it. I also suggest that one should contact their Attorney General's office. If accepted, they will take your appeals, place an AG cover letter to it and fax it over to their contract over at your HMO's legal department.
My HMO guidelines say that I need to meet 3 criteria and then a choice of another 3 to have nasal and sinus surgery. I met them. My HMO is denying me on the basis that I have not proven that I specifically have sinusitis in my frontal and maxillary sinuses. The guidelines specifically say that I need to be diagnosed by my dr. with sinusitis in 3 or more visits. The gudelines don't require me to prove sinusitis in each sinus, which are the grounds they are denying me on.
In the mean time, I am suffering in great pain from my sinus headaches, and my nasal blockages are causing UARS which is disabling me. I'm so frustrated that I can't get the services that I paid for.
I'm a web designer -- a client of mine, healthinsuranceinfo.net -- has published three guides related to paying for health care and getting the health care you need, under the collective title: "Managing Medical Bills: Strategies for Navigating the Health Care System". They're available for free online, go to www.healthinsuranceinfo.net/nefe.
This web site is a project of Georgetown University's Health Policy Institute -- completely nonprofit, with no industry funding, and very trustworthy and consumer-focused. I highly recommend the guides, and hope someone finds them helpful!
xmy question is when a patient arrives at his or her doctors appt on time and we have all been there usually abut 45 min you finalliy get into the room then wait another who knows how long where does the mgmt of doctors get the nerve to bill a patient who may have forgot a doctors appt i recenty have expierence this and had recived a 25.00 billl for a no show now dont get me wrong i understand that office visits should be taken with respect but ther is a flip side to this coin is that doctors are being extremelly hipacritcial on this issue its ok to make a patient wait as tho there time is of no value every time i visit but to bill me for a fraction of the time compared to the time they have wasted for me not even a courstey call likesome doctors do i believe this is greatly out of control i dont see how this can be legal thanks ken whos only human .
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