Fighting with insurance companies over whether or not they will cover a claim can be one of the most frustrating and agonizing aspect of working in the medical field. Too often, clinics and physicians spend so much time trying to get an insurance company to cover the costs of certain procedures that they lose time working with the patients who need them.
Health insurance is one of the biggest topics in politics today.
The basic premise behind the Affordable Care Act is to reduce the overall cost of healthcare. The law precludes insurance carriers from denying coverage for preexisting conditions and it also allows younger individuals to remain on their parent’s health insurance plans until they reach the age of 26.
According to reports, Florida’s health care workers are having trouble affording health insurance. The whole thing is somewhat ironic, as these people are within the industry.
For those of us who have had health insurance for a while, the likelihood of being denied for a claim is pretty high. But what if getting a genetic test could be used against you so that you weren’t able to get insured in the future?
Commercial insurance providers cover a critical therapy program for children with autism. It’s called applied behavioral analysis and autistic children who go through the program usually experience dramatically positive effects on their condition, bolstering their language and cognitive abilities as well as improving their social interaction and behavioral skills. The program comes at a financial cost though, leaving impoverished families with little chance of sending a child with autism through ABA.
Tell anyone in Miami that health care insurance is expensive and he or she will respond “Tell me something I don’t know.” That’s why it is extremely frustrating for people when they experience problems with their insurance, like a denied claim. Understandably, they feel they have been paying a lot for this protection and do not understand why it is not there for them when they need it.
When a health insurer denies a claim, health care providers typically suffer the consequences. In some cases, the policyholder may pay the bill themselves. If not, doctors and hospitals end up losing revenue they are owed for services they provided. However, recent data collected by the Government Accountability Office (GAO) suggests that a denial of a claim for health insurance is not necessarily the end of the road. The report discovered that nearly 50 percent of rejected claims are actually reversed on appeal.
It is usually policyholders and health-care providers that must go to battle over health insurance. But many Florida lawmakers have been busy fighting within the health insurance arena, by attacking the federal law requiring health insurance coverage for all Americans. Many politicians, including Governor Rick Scott, have found the health-insurance mandate to overstep the role of government in the lives of Floridians.
If nothing else, the health care debate has produced some interesting studies. The most recent, released this week, zeroes in on pre-existing conditions. A pre-existing condition is defined as a health condition that exists before a person submits an application for health insurance. In truth, it is one of a list of health problems that require elevated levels of care, either acute or chronic. Insurers are notorious for denying or limiting coverage because of a pre-existing condition — and, of course, because of the costs associated with the condition.
