The Harsh Reality of Health Insurance

Posted on August 5, 2020 by Chip Merlin

It’s no secret that most insurance carriers don’t want to pay up, and it’s no different in healthcare

Health insurance, or the lack thereof, has been a hot-button issue in political circles for years. Just think about the Affordable Care Act, otherwise known as Obamacare, that got pushed through Congress in 2010. Regardless of where you stand on healthcare politics, the simple fact of the matter is that the most recent statistics from the US Census Bureau indicated in 2018 that 27.5 million Americans didn’t have health insurance.

Upwards of 22 million Americans lost their jobs due to the coronavirus in April and May, according to the US Bureau of Labor and Statistics. Sadly, many workers lost their employer-based health insurance as well. The Kaiser Family Foundation estimates that 26.8 million Americans have lost their employer-based health insurance because of coronavirus layoffs.

Obviously, millions of Americans are in a tough place, and those of us who have health insurance in one form or another aren’t out of the woods either. The system is broken for many reasons, and it’s not just that healthcare coverage is unaffordable for lots of people. The system is set up to pay out as little as possible even as insurance companies jack up premiums. As healthcare costs continue to soar, the problem will only get worse.

Two big issues exist in health insurance in the United States. First, health insurance companies go to great lengths to avoid paying for expensive treatments. One of my attorneys has a son with cancer that could only be treated with costly drugs, and the insurance carrier balked. Fortunately, my colleague knew the law. She possessed the financial means to fight for her son, and she didn’t give up. Her son got the treatments he needed.

The squeaky wheel often does get the oil. If you find yourself in a dispute with your health insurance company, don’t be afraid to stand up and fight for your rights. Insurance companies will try to get out of paying, but they also don’t like hassles. If you make enough noise, chances are they’ll pay the claim to make you go away.

The second big issue with regard to health insurance companies is that the claims departments are trained to nickel-and-dime you to save money. The company will cover some things, and it will refuse to cover other things that actually should be covered. The thinking is that if the company can avoid lots of small payouts then the collective money saved will go right to the bottom line. Such an approach creates an adversarial relationship between the company and its insured, and that stokes bitter consumer frustration.

Everyone needs health insurance. It’s just a shame that we often have to fight for the benefits that we’ve already paid for.


Justice For The Policyholder

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