The Blame Game…

Most people know that I am not a fan of insurance companies. In a nutshell – They make too many mistakes when it comes to acupuncture claims. However quite a few times – they get the blame when actually it’s the patient’s fault. Yes, I said it- claims don’t get paid and the patient is to blame – The reason? Many people WITH insurance don’t know what they have. They are more concerned about their copay then to take the time to see what is covered in their benefits package. However when their claims aren’t paid, they are the first to blame their insurance carrier.

Insurance is a product. You buy a carton of milk, well you’ve got so much milk, a quart or a gallon. People pay MUCH more money for their health insurance but aren’t clear about what they’ve purchased,. They feel they’ve purchased “peace of mind”, that their bills will be paid and they will save money – BUT it just isn’t as simple as that. The consumer has to look at WHAT they have purchased, OR – what their employer is providing them, doing that can take work, and frankly some people are too lazy to do that work.

I have lost count of the number of times I’ve heard a patient say – “I’ve got GOOD coverage” – (Yeah, but you’ve just made an appointment for acupuncture and it doesn’t cover acupuncture). I’ve also had people assume they had NO acupuncture benefits, when in actuality they had great coverage, so it works both ways. These assumptions happen because patients don’t take the time to find out about their own coverage. They lost “their book” – the Summary Plan Description they were given when they got the coverage. Well then PICK UP THE PHONE, call member services and ask – By LAW benefits cannot be a “well kept secret”. Every plan has a Summary Plan Description that explains in common language WHAT is covered and WHAT is not. The SPD IS the bible of coverage. Every patient should be aware of their SPD – but most aren’t. IF they can find the book, they’ll look at the first few pages to find out how much is it going to cost them without realizing they need to make sure that the care they want IS actually covered.

There are plenty of laws in place to insure carriers follow what is written in the SPD. If you buy insurance every state has a Department of Insurance that oversees insurance companies so that get what you pay for. If your benefits come from your employer, the Department of Labor has created offices that will also assist a patient so that he can utilize his benefits- BUT every patient must KNOW what he has in the first place, and a lot of times that’s where the problem starts.

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