I say, I am a dreamer, just like the John Lennon song.
I certainly dream of health insurance that actually covers people’s health needs. Insurance that doesn’t deny needed services especially for the mentally and chronically ill. I wish I didn’t have to explain to parents why their child with a life threatening illness, can not go to a specialty doctor because the insurance won’t cover it. Or why the much needed test is being denied because the insurance company has decided it isn’t needed.
I also wish the insurance companies would be honest and straightforward as to what the criteria for denials are. I tell my clients there is no ryhme or reason. I once had an insurance physician reviewer tell me he was going to deny the surgery because he didn’t like the type of surgery. I explained there was research that showed benefit for situations like my clients but he just didn’t like it. Is that a good enough reason to deny it?
I also had a physician reviewer deny payment for an inpatient drug rehab because the medical director hadn’t called him back. He wrote in the insurance note that he hadn’t called and therefore my client didn’t need treatment.
The response in the media from insurance companies is “we are containing and controlling the cost of healthcare”. Yes, that is happening by increasing deductibles, copays, coinsurances, premiums, limiting consumer choices and denying claims and healthcare. Why, I ask, does the industry have such a stranglehold on my healthcare? Because they can.