Medical Insurance Coverage

Demolocke’s Agenda Article/Post Caveat (Read First Please: Click the Link)

In recent articles it has been said that even having insurance may not be enough because many full coverage insurance holders are seeing bills for Doctor’s services added on but no covered by your insurance. As the complexities rise on how and what and when we are covered, all driven by profit margins and legalese, etc., we as consumers and covered recipients must remember to remain vigilent and ask before receiving care.

We as people look to the medical industry as the authority on medical services and coverages but that is no longer true. I received two previous billings from my dental insurance saying additional charges not covered will require payment directly to the medical provider. In the past the same services have always been covered so I now have to take charge and ask my doctor why that bill is being sent and not covered. I ask because if they are raising their charges above and beyond coverage and IF the coverage has not changed by reductions in coverage then I have been subjected to costs while not being informed BEFORE HAND by either the insurance, if their coverage has changed, or the doctor, if they raise their charges above the coverage, who should let us all know.

Yes, they use the excuse that all insurances coverage shall be our responsibly but we all know that social conditioning and the medial industry has always taken charge, for their convenience, of charging insurances, etc. Personally, I appreciate it and look to it for that service but the recent charges from doctors in the plans adding in charges to make more money might seem ok but in truth to most who rely on insurances often don’t have or keep that kind of money available to pay out those charges. So, I have a recommendation:

Use the same process people use to have DNR’s, do not resuscitate orders, and always ask before accepting medical services, “Are any of these services you are providing today not covered by my insurance and are there any additional charges from doctors for services rendered that will not be covered by my insurance?” If yes, then express that you “Do or Do Not want or will accept services with additional charges at this time unless it is explained that refusal will result in life threatening dangers.” 

I really believe that both the person covered by the insurance, the medial facility providing services and the insurance providers should inform customers of such changes. As customers we have a personal obligation to make sure services are covered by asking or checking before services are provided and/or the medial provider should be able to tell us if any services are going to incur charges outside of coverage so the person can plan or refuse services. As to the insurance providers they do send out packages, huge convoluted data saturated packages, for our review on coverages and changes but hey, like the law, who can provide accurate and adequate answers before seeking services. 

It is a bit like the tax laws, no one person, even tax professionals and lawyers including the IRS itself, can keep track and properly explain how they work and what effects it will have on taxes and tax payers YET if something goes wrong, we the humans on the receiving end often in understandable ignorance, we the humans suffer the grave consequences. I feel it is about time those others out there like the medical providers and insurance providers work together to make sure we don’t incur unexpected and economically harmful charges like the add-on doctor fees from hospitals and ER’s and so on especially when you consider that often they are incurred during emergency provided services.