The state of Maryland is doing something rather unique with health insurance. It has launched something called Insurance Watch. It will allow physicians to report abusive health insurance company practices. It will also help doctors to provide assistance to consumers who have had their legitimate claims denied.
It is difficult to find an affordable health insurance policy that actually covers a reasonable amount of health care. Once a person finally locates a good plan, and gets approved for it, the expectation is that the insurer is going to actually live up to the promises it made when it was trying to sell the policy to the consumer. It can be completely aggravating to use a new health insurance plan only to learn that the insurer decided to deny your claim.
Many consumers are unaware of how to go through the appeals process after their claim has been denied. Sometimes, the process will require assistance from the person’s doctor, (which they may or may not get).
A study done last year by the Government Accountability Office showed that around half of all appeals that were made regarding health insurance claims resulted in making the insurer reconsider and actually pay the bill. Of course, if you don’t know how to start the appeals process, then your denied claim will never be paid by your insurance company.
The state of Maryland is doing something about this problem. MedChi, the Maryland State Medical Society, and Maryland Attorney General Douglas F. Gansler have announced the creation of something called Insurance Watch. It is a web portal that will be used by physicians. The physicians can use Insurance Watch to report abusive insurance company practices, and to provide assistance to consumers who have been denied their full health insurance benefits.
When a doctor in Maryland submits a complaint, it goes to the Health, Education and Advocacy Unit (HEAU) of the Office of the Attorney General. It also goes to the Maryland Insurance Administration. The Insurance Watch portal will direct both health care providers and consumers to the professional assistance that they need to make sure they are receiving their full benefits.
This is a good tool to help keep consumers from having legitimate health claims denied by their insurance companies. It would be even better if legislation could be made that prevented insurers from using “loopholes” to deny the legitimate claims of consumers.
One example of a “loophole” is something called prior authorization. It means that a doctor has to go and get the approval of the insurance company for certain medications or procedures before the treatment is given to a patient. This can result in a delay of necessary health care. If the doctor doesn’t wait for approval, then the insurer uses that as an excuse to deny coverage.
Image by 24oranges.nl on Flickr