Health care decisions can be made by two types of people. Someone with a profit motive and will deny you treatment and coverage to benefit him/ herself or someone without such motives. Then there are those who think that these decisions should be made by people with political motives. As far as making decisions outside the physician- patient relationship is concerned, this refers to decisions about coverage or funding. To be more precise, these are decisions that deny patients a cover for a certain procedure, which is denied to all apart from the affluent or the highly committed ones.

Basis in which healthcare decisions are made

In a typical world, such decisions won’t be necessary as there would be sufficient funds for covering any kind of service for all patients in need of it. In such a case, there would be no need to ever make such decisions. However, this is just pure fantasy as things are completely different in the real world where healthcare decisions are made on the basis of cost efficiency and efficacy, with great flexibility and putting interests of the patients first. Can you trust car insurers to make such decisions in an unbiased and neutral fashion? They can never do so as long as these organizations are driven by profit motives. A look at the history of these insurance companies shows that their behavior in this ranges from slightly sleazy to immoral and completely illegal behaviors.

The cunning behavior of insurance companies

Most insurance companies are known to have a history of failing to pay the policy holders for the services they render. One of the most common tactics used by these insurers is going through the claim submission form or medical record and finding some minor errors or emissions that they capitalize on to deny any payment for the claim on this basis. Some of the cunning companies write ‘edits’ in their billing software and this automatically denies policy holders payments based on this criteria. Most insurers have widely abused this practice thereby promoting ‘prudent layperson’ legislation enactment in most states. These insurance firms know too well that some of the claim they reject will either be paid by patients or the doctors will write off the claim and this is pure profit to them.

Other insurers bundle multiple services automatically into a single lower payment while others will substitute a certain service for another one without a justifiable reason but because they simply can and won’t hesitate doing it. The drive for more profits by players in the insurance industry has also been a great burden to the patients as well. They deny or delay authorization for patients to get treatments recommended by the doctors. Some impose rather difficult requirements for pre- authorization and documentation hoping that some of the claimants will with time lose interest and opt to try other options.