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Just to give the flip side of this, i worked in the healthcare industry and talked to a few insurers in my day to day job. There were no lack of stories of the
by refurb 4y ago
Just to give the flip side of this, i worked in the healthcare industry and talked to a few insurers in my day to day job.
There were no lack of stories of the insurer calling a doctor who had just prescribed, off label, a $100,000 per year cancer drug where the insurer calls and says “why did you prescribe this? can use you support the use of the drug for this type of cancer?”
And the answer was “no, i had just run out of options for the patient and felt like i had to give them something”.
- Clubber 4y agoSure, but the recourse for the insurance companies is just to deny it; problem solved. What recourse does the patient have when the insurance company denies a legit claim? Nothing, except hiring legal council when you have a severe illness, probably unable to generate your normal income, with a newly acquired massive amount of debt which affects your ability to borrow. Insurance, by structure, is a conflict of interest. The people you give money to to pay it back when you need it are the same people who get to decide if you get the money back or not. Insurance companies are bound by some legal constraints, but they also have a quite capable legal team to find loopholes in those constraints, and have practiced at this for decades. Even if they're wrong, they can just deny it and fight a long drawn out battle in court hoping you'll just quit, which given your new circumstances, you probably will have to. Your family might be able to continue to fight after you've died though, so there's that. You're simply outmatched.
- refurb 4y agoInsurance is highly regulated in each state. If you escalate to the state regulators (which you can) the insurers take it very seriously because if they're found to be in the wrong, the penalties aren't fun.