Health Insurance Bad Faith

03 Mar

One thing that “most” people rely on is that health insurance will take care of them if they are ill.  The term “most” people is used, because we are speaking about people who are fortunate enough to have group health insurance through an employer.  Prior to Obamacare, a self-employed person could not buy health insurance that covered pre-existing conditions.  Any policy that could be purchased was usually expensive and worthless.  Now, no one knows whether we have Obamacare or Trumpcare or much about how the competitive marketplace has changed. So, now, you are fortunate enough to obtain health insurance, and you turn in your claim.  It is denied.  Well, to the side of the insurance companies, either it is covered or not.  However, the seminal question is whether or not it really was covered. Often, health insurance policies are laden with boilerplate, adhesive language that makes no sense and “exclusions” that are never properly defined.  Additionally, health care providers are pressed into the cubbyhole of presenting procedures in “medical codes.”  Any reasonable person knows that a condition could have multiple implications, but it has to be turned in as a “code.”  The multiple implications should be covered, but the code is not.  So, you’ve paid years of premiums and are stuck with multiple bills for ambulance services, hospitalization and doctors’ visits.  Even worse, you may not be able to be treated at all.  Then, you think that litigation is the simple solution; however, after years of battling deep pocket insurance companies, you are simply worn out if not permanently disabled or dead and have a handful of collections accounts. Just as any author knows that you can’t write a novel in a mission statement, any patient or doctor knows that you can’t completely describe a medical condition by labeling it as #8675309. When you commit yourself, contractually, to a health insurance policy, be sure to read all of the language carefully, question everything and consider your other options. Should you have any questions, click on WWW.KJONESLAWYERS.COM or call us at (423) 424-6208.

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