subject: Getting What You Pay For From Your Insurance Company [print this page] Bad wraps seem to always find themselves at the door of insurance company's consistently. Could it be that some of the complaints are valid because parts of the policy are too vague and unclear. It is usually when you have to file a claim that the bad news is explained and the previous confusion is made perfectly clear. It is amazing how many unexplained holes appear after the fact.
One example of what is happening in the insurance industry across the board is a high rate of claim denials in all areas, that can make bad news more devastating for the policy holder at their most vulnerable personal moment. If you have first hand knowledge of such claim denial practices, you know how frustrating this can be for anyone. Your first option is the appeal the denied claim through a insurance company representative that still probably won't be approved.
Most all the major claims can expect to be denied initially, but if you are just doing a routine visit or routine checkup and preventive care you probably won't have to worry about this claim being denied. More serious health related diagnosed issues are a different story all together and you will begin to see the cracks appear in your claims and no longer treated like you are the valued customer, especially if the claims start to become too expensive; how sad and sobering this can be for a policy holder. This has all the earmarks of showing just how expendable your insurance company considers you to be; or if you are healthy we want your money, if you get sick, you are on your own.
The U.S. government acknowledges that this is a situation that many insured individuals face and as a result the current health care reform is designed to help address this problem. In this new act the government tells insurance companies that they must allow people to know about the appeals process and how to file an appeal. They also require the insurance companies to go through the appeals process in a timely manner and that they not only have an internal investigation conducted on each appeal but also an external one as well.
This change is one that is for the better and should help those who have had their claims denied to get their appeals handled more effectively than ever before. Ultimately, these changes will show the insurance companies that they need to stand up and take notice and having someone looking over their shoulder might be just the thing that is needed to push more claims through the first time around.
by: Ethan Kalvin
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