Basic Healthcare Reform and Bill of Rights, Part II
Here is a story- strange but true. Mr. Martin came to my office after he had a fracture of his thigh bone near a hip replacement that was previously put in.
As it turns out, I am not in Mr. Martin's Health Plan. Mr. Martin decided that even though I was not in his plan, he wanted me to reconstruct his femur and fix him.
He was pleased to know that the hospital I am affiliated accepts his health plan as does the Anesthesiology Department there. When he called his health plan here is what he learned (I am not making this crap up):
Since I was not in his health plan, the plan was now treating my hospital which is in his network and the Anesthesiology group (in Network) as out of Network providers and they would not pay their bill. Their reason was that it was "their policy."
When Mr. Martin told them that the reason he chose their plan was because of the fine hospital and he was willing to pay my fee separately- they say- no dice. If you choose an out of network doctor- all in-Network providers and hospitals are now not covered.
How in the world did the Department of Health allow this policy to happen? Did some just wake up in Albany and decide they were going to act like idiots and cower to the insurance company whims at the expense of patient's?
This interesting policy is NOWHERE to be found on any literature supplied by the company in enrollment materials and they could not even show me this in writing when asked. In general, I do not care to mention specific company names in this column because nearly all of them are guilty of this.
Why can't we have Health Plan nutritional information sheets mandatory? Is it so hard for someone to list the particulars of a health plan and the rules and regulations?
Here are some mind-boggling facts that may need to go on the box of your health plan enrollment kit:
1. Monthly fee
2. All co-pays
3. Exactly which tests are approved and which are not
4. Exactly which tests need precertification and which do not
5. Where is the published list of ALL the medications
I would be most interested in many more comments the readers have on what information health plans should provide.
Related Topics: Health Insurance Education Center
, Mental Health Insurance Pays
Technorati Tags: health insurance, insurance enrollment, policyholder rights
As it turns out, I am not in Mr. Martin's Health Plan. Mr. Martin decided that even though I was not in his plan, he wanted me to reconstruct his femur and fix him.
He was pleased to know that the hospital I am affiliated accepts his health plan as does the Anesthesiology Department there. When he called his health plan here is what he learned (I am not making this crap up):
Since I was not in his health plan, the plan was now treating my hospital which is in his network and the Anesthesiology group (in Network) as out of Network providers and they would not pay their bill. Their reason was that it was "their policy."
When Mr. Martin told them that the reason he chose their plan was because of the fine hospital and he was willing to pay my fee separately- they say- no dice. If you choose an out of network doctor- all in-Network providers and hospitals are now not covered.
How in the world did the Department of Health allow this policy to happen? Did some just wake up in Albany and decide they were going to act like idiots and cower to the insurance company whims at the expense of patient's?
This interesting policy is NOWHERE to be found on any literature supplied by the company in enrollment materials and they could not even show me this in writing when asked. In general, I do not care to mention specific company names in this column because nearly all of them are guilty of this.
Why can't we have Health Plan nutritional information sheets mandatory? Is it so hard for someone to list the particulars of a health plan and the rules and regulations?
Here are some mind-boggling facts that may need to go on the box of your health plan enrollment kit:
1. Monthly fee
2. All co-pays
3. Exactly which tests are approved and which are not
4. Exactly which tests need precertification and which do not
5. Where is the published list of ALL the medications
I would be most interested in many more comments the readers have on what information health plans should provide.
Related Topics: Health Insurance Education Center
, Mental Health Insurance Pays
Technorati Tags: health insurance, insurance enrollment, policyholder rights
