Heath Insurance

05 Jul: HEALTH INSURERS THINK THEY HAVE THE UPPER HAND WHEN A CLAIM IS MADE: DO THEY?

Health insurers provide insurance protection for consumers of medical service for their care – who does not fit that description? So, the question is: what kind of insurance protection do we get when we incur medical bills and claim is submitted to our health insurer? To answer that question we need to look at how health insurance works. There are three types of health insurance programs (not including Medicare which is a somewhat different):  individual plans, association group plans (through a common association), and employer sponsored “group” plans.  Each has its own benefits and rules. The premium charged for health insurance is based on the level of risk the insurer will assume. It must put limits on that coverage, and subject to federal and state laws, it has every right to do so.  So, it is never going to agree to pay what is billed. It claims it needs to…