When you have Health Insurance Coverage that just won't Pay

What would you do if you had health insurance coverage for your wife who had heart disease, but if she felt like she had a heart attack approaching, your hospital denied her treatment because your health insurance company just refused to cover for any of the important tests involved?

The Senate Commerce Committee, investigating shocking behavior by the nation's health insurance coverage providers, has uncovered a pattern of completely egregious denials for test for serious diseases that should have been allowed. The investigation, that ran for six months, looked at nearly 2000 cases where patients with full health coverage were denied important tests to do with coronary artery disease. In all, about one in six Americans suffering from heart disease has been putting up with this kind of cruel denial of health insurance coverage. What exactly is going on here? How could they do this?

They could do this because doing this saves them money. Interestingly enough, the health insurance companies don't do the denying, themselves. They outsource the work of studying requests for tests that come in from doctors and of deciding whether the requests are reasonable. In most of the cases where patients have been illegally denied treatment, this kind of outsourced work was handled by a company called MedSolutions.

So if you were a company that studied doctors requests for tests for a health insurance company, why would you unfairly rule requests for tests as unnecessary? Well, if you were a company that vetted doctors' requests, you would want to appear useful, wouldn't you? The more requests you flagged as unnecessary, the more useful you would show yourself to be and you would stay in business. Perhaps, you even get paid an incentive for finding ways to deny requests. Yes, the rot runs deep.

So, do they really deny tests to patients who really seriously needs them for life-and-death situations? There have been cases that the Senate Committee has uncovered where patients would have died in 2 to 3 days if they had not received the recommended tests. Because their arteries were almost completely blocked. The worst part of it all is that these companies that take on work passing or denying requests for tests do not even employ qualified people. They just employ anyone; because, you know, that would save money.

And insurance companies have felt the need to be strict because left to their own devices, doctors just prescribe expensive tests left and right for no reason. Okay, it's not for no reason; it's because doctors and hospitals often own expensive test equipment and the more they recommend tests, the more money they stand to make. Once profit gets into healthcare, people completely lose their bearing.