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Gary Shipman
Gary Shipman
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Health insurance companies – Who's the real Sicko?

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You and/or your employer pay valuable money for the premiums on your health insurance. You’ve been told what your coverage includes and doesn’t include. You have a “basic” understanding of what your contribution may be (i.e. co-pay). You therefore gain a piece of mind (albeit a false one) that when you or your family needs medical treatment, “cost” is no longer an issue. How wrong we are.

Michael Moore’s latest documentary, “Sicko”, opens this week in theatres around the country. If you wish to maintain this false sense of security, don’t see the movie. If you wish to gain the knowledge of just how unsecure you and your family are, rush to see the movie, and then see it again.

Insurance companies that write health coverage are like every other insurance company – they are in the business to make money, for their employees and shareholders. The premiums that they charge are supposed to be representative of the risk that they take in insuring you. For the most part, the insurance companies “win” that gamble, because most people covered by a policy of health insurance won’t ever have to call upon the insurance company to pay the full range of benefits called for under the policy. Typically, we use our insurance when we go to the emergency room when our child breaks an arm; when we have a prescription filled; or when we undergo routine medical examinations. The false sense of security comes from the notion that if “we really need them”, i.e., in the event of a catastrophic medical condition, that the insurance company will stroke the check while we or our family gets better. Well, people, that’s not the way that it happens.

Insurance companies routinely attempt to dictate the level of medical care that you receive, and unfortunately, because doctors and hospitals have become so dependent upon insurance companies to get paid, medical decisions can sometimes be made on that basis. We hear complaints from health care professionals about feeling manipulated by insurance companies. Health care professionals are forced, sometimes, to provide medical care at “below market” rates in order to become an “approved provider.” The term “medically necessary” becomes a term of finance, and not one of medicine. If the insurance company won’t pay for it, it’s not necessary.

So, are you powerless to do anything about it? What happens if you’re facing a “medically necessary” procedure, but some person in Illionois sitting in front of a computer screen, who has no medical background, says that it’s not? CALL A LAWYER!!!! Health insurance companies, like property, casualty and auto insurance companies, are required to act in “good faith” when processing a claim for benefits. There are statutes that provide what an insurance company can and cannot do, and set forth remedies for consumers in the event that an insurance company acts in bad faith. Our office routinely advises consumers with the insurance questions, and when necessary, institutes legal action against them to insure that they comply with their obligations. KNOWLEDGE IS POWER!!!

So, understand that the real “Sicko” isn’t you; it’s them.