Insurance games
I am always amazed at the games insurance companies play. Some insurance companies are more forthcoming in their payments. Many will wait and deny until the client appeals. Reasons for denials for care from doctor or hospital range from not in network(when actually in network) to billed with wrong codes (when codes are correct). I think everyone knows the game. It keeps the insurance company money in the bank accruing interest. payments are stretched to the maximum. it is important to thoroughly read the insurance handbook. On speaking to an insurance company, a good knowledge of your plan helps. for instance, one company denied initial hospitalization for an assault victim because the victim was taken to the only trauma center in the state not considered in network. However, the plan stated that if in an emergency situation deemed if a client was taken to an out of network facility because it was medically necessary, it would be considered in network and paid in full. The insurance company originally tried to deny the claim stating it was out of network. Luckily for the client, I was involved and had read the policy. Also, on further investigation, the trauma center had filed a prior approval upon arrival of the client by helicopter and gotten approval! There was no latitude to deny although, there were a few back and forth about paying a coinsurance of 40%. The message is when dealing with insurance companies, be on your toes!
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