Hassles with Getting Health Claims Paid

We have excellent health insurance coverage through my husband's job. In fact, many of the "alternative" health professionals that I make use of are covered (up to a certain yearly limit) by my husband's health plan. Since I prefer preventative medicine to actually getting sick and needing a doctor, I'm very happy about the kind of coverage we have.

One of the professionals that I make use of is an osteopath. If you aren't familiar with this kind of practitioner, you might want to be! I used to have a bad back; my osteopath has treated my back and left it more stable than it ever was before. He did this without turning me into a "junkie" who had to go back to his office every week. In fact, I have had much better results with my osteopath (in a visit or two a year) than any other back professional (including chiropractors) and would highly recommend the profession in general.

I digress.

My husband's health plan covers osteopaths. I've seen the same guy for years. Yet, every time I make a claim for this kind of service, it is initially denied. Why? Good question. Each time (about every 6 months or so), I'm asked to provide additional documentation, including a copy of my practitioner's certification.

Now, most insurance companies have really good information systems. They have to; their whole business is about measuring, managing and reducing risk. I'd have to assume that they have on record that this professional is someone that I've seen before, and that claims for his services have been paid before. Yet, each time, my claim is initially denied.

Are they hoping I'll go away? Perhaps I'll give up because of the time and hassle it takes me to get the supporting documentation all over again? It's quite possible; if the money they owe me stays in their pocket longer, that helps their bottom line.

It's frustrating. Insurance companies are expected to "do right" by their shareholders. They are expected to "do right" by their employees. They are expected to "do right" by the brokers and agents who sell their product. But the people who actually purchase the service of the insurer? It seems easiest for the insurer to give the "customer", the one who keeps them in business, the shortest end of the stick.

Posted by Tom Quigley on September 3,2006 at 10:37 PM
If small business owners would get rid of the first $5,000 in claims and hire a TPA to manage it they would save a lot of money and headache.
Posted by Wayde on August 30,2006 at 9:14 PM
neat blog, thanks for the great info on insurance
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