What Health Insurers Don’t Want You to Know

In a recent article, “Coding & Billing: 10 Things Insurers Don’t Want You to Know”, Karlene Dittrich, CBCS, lists 10 things health insurers don’t want you to know. These 10 things include:

  • Insurance companies may not be focused on quality care or what’s best for their customers.
  • Insurance companies are required by law to pay claims.
  • Insurance companies cannot rescind policy coverage once a claim has been filed.

Insurance companies also don’t want you to find out how they’ve decided on other claims. Take the case of Kevin Dwyer, who has cystic fibrosis, “a deadly disease clogging the lungs, causing dangerous infections, even internal bleeding”.

NBC News reported that Kevin was repeatedly denied a drug that his sister was receiving for the same disease.

It was only after NBC contacted Kevin’s insurance company, United Healthcare that the situation changed. As NBC reported:

We contacted United Healthcare for comment on our story: Why were they denying his claim? And we got action. United Healthcare did a complete reversal and has now approved Kevin’s claim, due to the “unique circumstances” of his case. So he’s finally getting the drug.

In short, the knowledge of what Elisabeth Benjamin, vice president of health initiatives, Community Service Society of New York referred to as “random” decisions and the threat of negative publicity by NBC News changed United Healthcare’s behavior.

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