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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: John Koligman who wrote (3503)	12/27/2007 8:42:59 AM
From: Lane3	Read Replies (1) \| Respond to of 42652

they pretty much said many insurance companies do try their BEST to avoid paying, and make them spend WAY too many hours fighting with them. I know that. I am not denying that. I recognize that insurance companies will look for outs wherever they can. They're not going to pay for anything they don't have to. Like, duh. But it is irrelevant to my point. My point was that you could read the contract and find out what they won't pay for up front. You haven't said anything that would contradict my point. Perhaps you were too busy laughing at my presumed naivety to focus on my point. From what I know about HIPA there is no way they will give me specific patient data Aha. So you don't have an example from personal experience, an example you could camouflage and present to us. It never happened to you or to anyone who complained to you about it. So maybe it doesn't happen so much after all. Let me give you an example--my latest mammogram. Insurance generally pays for one mammogram a year. As I've posted before, I recently spent several months across the country taking care of my father. When I left, I thought I might be away for six months or a year. So, before I left, I wanted to get my mammogram, which was due a month later. I have a complicated one so I wanted to get it from the facility I've been using for decades and has my records. But they don't pay for mammograms at eleven months. To me it would make sense to get that mammogram at eleven months, then get next year's at thirteen months, back on my regular schedule. No harm, no foul. It wouldn't cost the insurance company to do it my way, but, if I just went for the mammogram at eleven months, they wouldn't have paid for it. Had I contacted them up front to ask for an exception, which I think entirely reasonable, they might have accommodated me or they might have held firm to their contract. I don't know because I didn't pursue it, but that's an example of where an insurance company might decline payment. They would be within their rights to do so but I and my radiologist would still be griping about their unreasonableness.