Wednesday, August 29, 2012

Denial Because...

I couldn't make this letter up if I wanted to. Therefore, I decided to post it for you.

If you read the letter you will see that the insurance company will not pay for the prior authorized visit to a doctor I went to "because"

Claims Department

That's right, they didn't say why, they just said "because."

It's okay to laugh. I did after I got over the shock of getting a denial letter for a prior authorized appointment.

The company is based in Florida and if this was my first rodeo with an insurance company in Florida I might think "oops, someone sent this by mistake." However, attached to this notice of denial is also my EOB (explanation of benefits) reiterating the fact that my insurance company (that I faithfully pay every month) will indeed not cover this appointment they authorized me to go to.

The truth of the matter is Florida has lax regulations on insurance companies. They're not the only state with these lax regulations, but you have to question why so many of these companies avoiding their obligations are based in certain states and not in others.

In general American's don't like "regulations"--- there is a fear that "regulations" will lead to a communist system. I think that's a bit of extreme thinking and there is no way our country would move briskly to a non-capitalist society based on regulations for companies who are clearly not working for the best interest of their consumers.

All regulation means (in this case) is the loopholes, games, and tricks these companies play to gain the most profits based on denying coverage would be accountable to review. I personally think that would only improve our health care system.

Or maybe we will all begin to accept letters without question that say "We will not cover your care, because."


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