Health insurance gets a bad reputation. And I wonder if people really understand the work that goes on when a review needs to be done for a pre authorization of a service. ( photo is from google images courtesy of www.wciv.com) There are so many stereo types of insurance companies, and I admit there may be some that are crooked, but I personally have worked in the administration part of health care for 13 years now, and I am here to say the hours of compassion, of work, of trying to make sure the patient is receiving the care their doctor is recommending and within their benefit plan, it is amazing how devoted the people are who have worked in the environments I have been blessed to be a part of.
People need to understand that sometimes they or their doctor may recommend something that their plan just does not cover. Some plans are stricter then others. We sometimes may get a person who wants their health plan to pay for a craft- matic adjustable bed, or maybe a home health aid to spend days with them and help clean their house, or a ride to a doctors office, but it is not a covered item. If health plans paid for some of the services and items people want them to pay for, the premiums would be higher then they are already.
When we get a request in, we have to follow national criteria for the type of care being requested. We do not just say yes or no without careful researching . And if it does not meet our criteria, we have to send the case to a physician to review, to call the doctor who is requesting the service and discuss the case. The nurses do not just make the determination if there is a potential denial of the request.
SO please, I ask you, to take a moment, read your health plan, and feel free to call the customer service department to see what is covered. Ultimately it is you and me who need to know what we are covered for, whether it is our home owners insurance, a life insurance plan, out health plan, even warranties on things we have.
The folks working for your health insurance administration department are experienced health care professionals, who have been in the clinical setting and bring to this position knowledge, experience and the want to be the best they can be. So please refrain from calling us names, threatening us, and yelling at us. We are looking out for you, your health plan and trying to accommodate the needs of each sapient, within the guidelines of the health plan they are paying for. Stay healthy, love Mrs Justa