Note: This is Part 1 of an 8 part series that is also being published in the Chester County Press.
When our parents needed healthcare, their health insurance guaranteed them the care and coverage that offered the “best possible outcome” as determined by their doctor. Today’s health insurance is very different. It has been quietly changed to guarantee only the least expensive “legally acceptable outcome” for an average patient as determined by an insurance company. Fortunately, the laws, regulations and contractual provisions that guaranteed our parents the best possible outcome and coverage haven’t changed. We just have to know how to apply them to get the care and coverage our parents could count on and we are still owed.
Unfortunately, having a right to this care and coverage is one thing and accessing it is quite another matter. The entire healthcare industry, and particularly the healthcare insurance industry, gives every appearance of only being interested in making the system more complex, beyond our understanding and dramatically more expensive. Consequently, we will be posting a series of articles aimed at helping our readers understand their health insurance and dispelling the mistaken beliefs that interfere with accessing the care and coverage we need and are owed. As Einstein observed, “You have to learn the rules of the game, and then you have to play better than anyone else.” So true for our modern-day health insurance.
Consequently, given the serious of the COVID-19 pandemic, we believe this is a perfect time to help you learn the rules of the road the healthcare insurance industry is using so that you are equipped to “play better.” Hence, the goal of our following seven posts will be to equip you with enough information that you can avoid the roadblocks and misdirection the healthcare industry is using to deny the very care and coverage we rightfully expect from our health insurance.
See Other Articles in the Series
What You Need to Know About Health Insurance Part 8
Note: This is Part 8 of an 8 part series that is also being published in the Chester County Press. "HMO, PPO HDHP or POS, It Really Doesn't Matter" When I first became aware of how easy it is for health insurance to deny coverage and care, the HMO was the dominant...
What You Need to Know About Health Insurance Part 7
Note: This is Part 7 of an 8 part series that is also being published in the Chester County Press. "Coverage Even When Your Plan Says No" In our last article we explained your healthcare plan’s essentially unlimited right to deny coverage and payment for the care your...
What You Need to Know About Health Insurance Part 6
Note: This is Part 6 of an 8 part series that is also being published in the Chester County Press. "Their Secret Provider Agreement" When it comes to accessing healthcare, we face two very separate realities. The first is the one Congress and the healthcare insurance...
What You Need to Know About Health Insurance Part 5
Note: This is Part 5 of an 8 part series that is also being published in the Chester County Press. "Your Doctor vs. Their Doctor" In our last article we stressed the importance of recognizing the subtle difference between denying payment for insurance purposes and...
What You Need to Know About Health Insurance Part 4
Note: This is Part 4 of an 8 part series that is also being published in the Chester County Press. "The Importance of 'Medical Necessity'" The healthcare plans we have today have their origin in the 1930’s and the Depression. Back then, the nation’s doctors and...
What You Need to Know About Health Insurance Part 3
Note: This is Part 3 of an 8 part series that is also being published in the Chester County Press. "Their Two Definitions for Covered Services" As much as the insurance industry would like us to believe that the “Covered Services” for our healthcare plan are the...
What You Need to Know About Health Insurance Part 2
Note: This is Part 2 of an 8 part series that is also being published in the Chester County Press. "It's Not Insurance" What we have been led to view as our very own health “insurance” doesn’t come close to meeting the definition of insurance. Yes, it distributes...
Letter to the American Medical Association’s President, Dr. Patrice Harris
AMA President, Dr. Patrice Harris AMA Plaza 330 N. Wabash Ave. Suite 39300 Chicago, IL 60611-5885 April 3, 2020 Dear Dr. Harris; Given the severity of the coronavirus pandemic and the magnitude of the healthcare bills facing the American people, how can you in good...