The Reality of Dealing With Health Insurance Companies When You Need Them-Fair?

unfair treatment

The bill for the monthly Health Insurance Premium always shows up on time and is typically sent out in the same fashion. My question is, why is it that there are so many delays, hiccups or whatever you want to call them, when you need to actually use your health insurance during times of need. Do they forget that we are all good and loyal customers who are counting on them 100%, to be helpful as well as timely, if and when we do need help?

I have personally dealt with Health Insurance Companies for decades, at my previous job as a clinical/administrative nurse. I typically served as a patient advocate and exchanged necessary information to get patient procedures authorized.  I can tell you that as long as you read the fine print and dot your i’s and cross your t’s that the process will go through. Our clinic was known for getting things done and more importantly, in a timely manner. We didn’t let the paperwork pile sit but rather spent the necessary time to get the project completed; sometimes missing lunch or staying a little late after work, fully well knowing that the completed task affected many other individuals who were also awaiting the decision. I can attest that our clinic was nothing but efficient and always went the extra mile to help our patients.

I know that everyone in the medical/healthcare equation are overly busy but a frustration I am currently experiencing, are time delays secondary to the requested paperwork trails. I find this unacceptable as I know that it merely takes an effort to get the work done, not putting the task in a pile and waiting til the clock starts ticking on when it legally has to be done.  Now that the majority of large health clinics and Insurance companies are on computerized systems, which are supposedly more efficient, why are we seeing more and more delays? It almost appears that the former method of data exchange via the US Mail was faster than our computerized systems.

Health Insurance companies now operate under regulations mandating time-frames, in an attempt to better manage themselves internally as well as to protect the consumer. I would think that since they expect our premiums on time, that they would in turn, put out extra effort to get their client’s work in/out on time. There is the realization that not all issues will fall into their regulated time-frames, which does not mean the level of importance should be downgraded or ignored. Then again, playing the Devil’s advocate, would the reason for the delays be secondary to the numbers of the actual people handling the paperwork, possibly being fewer and fewer secondary to the increase in computers/supposed efficiency, as well as the requests to them, more and more?

The levels of management increase as insurance companies grow, thus the layers and layers of bureaucracy increase with too many lacking the authority to make timely decisions. Is this a planned, stalling technique in order to avoid paying claims of the loyal, trusting clients, or, is this because the level of personal caring is no longer an attribute they look for in the hiring process? I’m torn as I’d like to believe that people really do care about people, especially when in need, but on the other hand, why do these companies have to incorporate regulations in order to make sure the paperwork is done on time?

I recently received a denial on a procedure which was staged, secondary to a need for notes from the Surgeon. Mind you, the denial came exactly 1 week prior to the date of surgery. The surgeon was contacted and I immediately sent out an appeal, clearly stating my frustration and time issues. Everything they needed/requested was in their hands within 24 hours. A follow-up call several days later informed me that the individual with the power to expedite said no, only because no emergency involved (per their documentation). I find this amazing, especially since their denial letter came less than a week before the procedure, which clearly defines the common sense need to be expedited. It would have taken maybe 5-10 minutes for a reviewer to make a decision; not a complicated case in that its staged. Now, because of one person’s decision, the people having spent a lot of time scheduling the medical facility and necessary medical people, now have their efforts come to a halt.

I know that there are times when a person’s workload is so heavy, that the last thing they want to hear is one more problem/issue, therefore, a personal decision might be made by that individual, to handle the ‘tipping of the iceberg’ only when they absolutely have to and no sooner; just because. Human nature is something that is real and can’t always be predicted or controlled., but that’s no excuse for a lack of human compassion in dealing with people in need. Tell me, this isn’t an example of our new, more efficient healthcare system. Is this an example of the service our increased healthcare premiums are paying for?

The loyal, trusting clients will need to step up to the plate and let it be known when untimely decisions are occurring and/or one is experiencing the run around. The names of individuals involved in these decisions are documented and can be attained for questioning if need be. Also, remember who’s paying the bill/premium! There are resources within each states’ governing bodies that are advocates for such non-professional practices. Realizing that the burden from Obamacare is almost upon us, be aware that the increase in the numbers of insured, will only delay the processes in place, even further. Don’t forget that our voices are the most powerful tool we have!



  1. Sharon's Miller says:

    Stated oh so very well! Thanks! Oh that the insurance “executives” and administrative staff would put some “horsepower” and common sense into practice on behalf of their insureds.

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