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Insurance Mess

One of the ugliest things I've learned in fifteen years in the counseling business is that I cannot trust insurance companies to do the right thing. You know, the right thing like pay care providers what they've said they will pay, reasonably cover services they've implied they will cover, accept responsibility for slow timing or poor customer service, pay a livable wage to providers, follow through with coverage they've promised to their customers, allow trained medical providers to make the best medical decisions about patient care. You know, right things like THAT.

Yet because the system is so big and dominates the medical community, insurance appears to be a necessary evil.

Sometimes insurance companies save the consumer money (or at least make your medical expenses easier to pay over a long period of time) and sometimes they support a livable wage for me. But did you know they can change their mind at any time with little to no consequence? You know, like if they decide they aren't making enough money.

They have big, legally and financially painful consequences set in place for me if I don't follow their rules (insurance fraud) or move as quickly as they want me to (billing deadlines). I accept these consequences as reasonable accountability for ethical business practice. But if they don't follow the rules… NOTHING HAPPENS.

For example, if I don't bill for your services within six months of delivering them, I am denied payment. But I've seen an insurance company come back TWO YEARS AFTER PAYING for a service incorrectly demanding money back. Show me a small business who doesn't balance their books for TWO YEARS and I will show you a business owner in deep doo doo with the IRS. But Big Insurance? I guess they have all the time in the world.

And how do they treat you, the customer? Have you ever read your insurance policy? Is it clear and simple? Have you ever noticed at the bottom of your policy where it says, "This estimate is not a guarantee of payment. Payment is subject to rates at the time of service." Know what that means? It means they can decide, AT ANY MOMENT that they just don't want to pay what it costs. There is NEVER a deadline for their take backs. So you tell me—does that contract or "policy," if you will, mean ANYTHING?

If it's unclear—why not just call and ask? Well… I've seen companies explain benefits over the phone only to come back after the service has been provided saying that somehow "the information you received was incorrect."

And guess who's liable for that "misunderstanding?" YOU. You are the one who has to pay the full fee or go into bankruptcy trying. And sometimes that means you're upset with me for charging you what I told you it would cost even though I can't take the service back NOR can I take back the charge (if it went instead toward your deductible) without getting charged with INSURANCE FRAUD.

You tell me—Who is responsible here? And who is being held responsible?

For now, until I can figure out a better solution, I plan to continue to accept some insurance as payment because it helps me care for clients who don't have good insurance. (Unless they come after me because of this blog—yikes!) But just know I am praying against that giant machine and I hope reform is coming soon.

Unsplash: Pavel Neznanov

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