The rules involved with using one’s medical insurance can be difficult to understand and tricky to navigate, and the worry over health care does not end when one acquires health insurance. All too often, this is the point where it begins. The purpose of health insurance is to reduce the cost of medical care by paying a premium, co-payments and/or a deductible. Unfortunately, consumers are finding that they have many more hoops to jump through in order to receive coverage. The latest is the 2004 ruling by the Supreme Court that prevents patients from suing their health insurance companies for refusing to pay for doctor-recommended medical care. This is an outrageous decision that favors the health insurance companies while discriminating against the consumer.
From 2003 to 2004, consumer premiums for health insurance rose an average of $1,000 per family, and the employee contribution to health coverage nearly doubled (Facts About Healthcare). In any other situation, such as auto insurance coverage or life insurance coverage, one would expect to receive more in exchange for the higher costs. This is not true of health insurance. On the contrary, these companies can decide which treatments and procedures are covered and which aren’t – often, consumers have little say in the choice of health coverage. The consumers who follow the rules are being cheated by the Supreme Court ruling. A patient who sees the doctor listed as an approved provider, then follows the doctor’s advice for follow-up care should have their medical costs covered by the insurance. The ruling allows insurance companies to select the most expensive treatments and procedures (such as transplants or coronary bypass) and refuse to cover them. The ruling did not provide guidelines to limit the ability of insurance companies to refuse coverage. Where does it stop?
If the current ruling is allowed to stand, we may eventually end up in a world where health insurance consumes a majority of one’s income and only covers basic check-ups. In order to prevent this from happening, the Supreme Court needs to rule that insurance companies must cover all procedures, regardless of the cost, though they can add an additional co-payment or deductible. Many health insurance companies have a basic co-payment, an additional co-payment for inpatient procedures, and a higher co-payment for hospital stays. The same standard should be used in attaching a payment schedule to doctor-recommended treatments.
(2004). Facts About Healthcare. Retrieved November 13, 2006, from NCHC Web site: http://www.nchc.org/facts/cost.shtml