I may have been an insurance agent in my past, and I might even understand all the reasons, actuary calculations, and claims adjustment issues involved from the companies point of view. But, I am also a consumer of the very products I seem to understand from the other point of view. As a consumer most often my understanding of insurance has helped me make better risk management decisions, deal with limitations of claims and all the other insurance ins and outs.
There is one area however, I have faced problems and confusion over and that is when health insurance dictates the treatment plan.
It has never made a difference to me who put the new bumper on my car, and frankly I don’t really care on most of my cars if it’s an after-market bumper. It’s just the car and I am willing to work with insurance adjusters on car parts and repairs. The problem I have is with health insurance claims, and the fact that too often I have personally witnessed medical treatment plans being based and managed by the insurance company rather then the doctors, and other professionals. When it comes to my family it’s a completely different story and not a car I’m dealing with.
The first time I saw this happen was when my oldest child had a horrible sledding accident which resulted in a $250,000 leg injury. At that time our health insurance was actually phenomenal, we worked for a Union company and the benefits were very nice. But, even with these wonderful benefit’s the insurance company impacted the treatment choices we had for our son. It wasn’t the big things, we had access to life flight, the trauma surgeons, best hospital, and amazing efforts. It was the little things primarily in after care where we found one roadblock after another. Our choices for physical therapists were limited. When and how often a home nurse visited was determined by our insurance company. The kind of medical equipment we could rent or buy was managed by our insurance coverage.
It’s happened to our family again, only this time the issues are more subjective, and deal with emotional and mental health matters. It’s nearly impossible sometime for people to actually understand what parenting an emotionally disturbed child is really all about. It just isn’t as simple as which doctor is covered under our plan. What is even more frustrating is to be dismissed when telling the medical community, the insurance providers and all other parties involved that “Money is NOT the issue, our child’s mental health and future is most important please make recommendations based on what is best for our child.”
It’s like spitting down a black hole! Recommendations always seem to be made with the phrase, “Your insurance company will cover this much of this treatment…” So, they recommend something based on what the insurance company agreed to cover! But, what is the right choice for treatment and why does it always seem to depend on the insurance company and claims adjusters?
We recently brought our eight year old daughter home from her second week long stay on the Children’s Psychiatric Hospital. The first was nearly two-years ago. Our insurance has offered to cover one month of the treatment that our child has already had for nearly two years. We know there are some better options, we know there are specialized doctors and services our daughter needs but, We have had to reject the recommendations and move forward with our own plan. Health insurance is wonderful, however some things are worth paying for ourselves. It would be nice if health insurance would include the real needs of the families it covers, rather then causing the medical providers to recommend treatment based on insurance matters.
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