If You Can’t Beat ’em Join ’em

I once worked as an adjunctive therapist in a very small private practice. The primary provider was routinely denied coverage for patients in a quite predictable pattern, and it would take insurance companies up to 9 months to pay for care provided that was precertified. As an experiment, this provider interjected actual looney tunes quotes from Bugs Bunny or Elmer Fudd into his requests for patient care to see if anyone was actually reading them before making determinations to approve or deny coverage. This went on for a year with exactly the same results as before and the insurance companies never once contacted our office. We thought that at worst, non-medical personnel were making healthcare decisions. Sadly, the system appeared to be automated and there were no actual healthcare decisions being made at all. Simply financial ones.

I have since relocated to take care of a family member that was disabled. Fortunately for us the insurance she had allowed for her to only pay $900 a month for her chemotherapy drugs on co-pay vs. the 3 or 4k they actually cost while on disability, which after taxes is like living on 50% of your prior income. The first job I was able to get was for an insurance company. In one year we submitted 75 individual health insurance applications for the wealthier clients only as a favor, most of whom were small business owners who either couldn’t afford to provide coverage for their employees or wouldn’t qualify since 75% of them would have to agree to pay for 1/2 the premiums themselves. Of those 75 only 2 were approved and only one at a rate they could afford without any exclusions on pre-existing conditions.

Tristen
Fl
Heathcare Status: Employer Insured

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