Both of the therapists I've seen made it clear up front that they refuse to deal with insurance companies, and expect payment up front. The health insurance industry would make Franz Kafka proud.
That said, I was surprised when I mailed a bunch of bills to my insurer, and requested reimbursement. I figured I was probably wasting my time, but why not see what happens.
Anyway, they mailed me a check. The bills were higher than what my insurance would cover, but my insurance decided to cover a substantial portion.
> The health insurance industry would make Franz Kafka proud.
The incentives are Kafka-esque. If you're a provider, your incentive is to maximize billable treatment, and you often have prospective patients who have an extremely limited capacity to evaluate your relative expertise/value bs other options, and they often don't have the time luxury of being able to shop around even if they did (and might be justifiably wary of selecting medical treatment based on discounts anyway).
If you're an insurer, you're selling a product with inherently cross-aligned incentives -- the people with the greatest need for it will not be able to pay enough in premiums to meet your risk pool, the people with the least need for it will have limited incentives to buy in. Good actuarial work can partially balance this out but at some level your incentives have to do with attracting/keeping those with the least need for your product and trying to avoid or ditch people with the greatest. On the other hand, other than patient bankruptcy, insurers are probably the single greatest (if limited) force for cost control in the US system, a fact which doesn't frequently win them any love, and thanks to a certain mix of legally compelled and inherent responsibility found in the industry they do at times come through for people, as your experience may indicate.
Given the incentives, the wonder isn't that there are problems for people and providers who don't want to work with insurance. The wonder is that it works at all, and that there is anyone who continues to focus on market solutions. Hayek was about as big a laissez-faire advocate as you can find in the history of economic thought and even he thought that public insurance had things to recommend it over solely private institutions.
Yep. A lot of people are unwilling to fight their insurance and the insurance providers are depending on this. Same with billing departments in the various healthcare systems, etc.
There's no reason to be surprised. This coverage benefit was probably clearly stated on your summary plan description. These are short, simple documents that most health insurance plans are legally required to distribute to members.
Perhaps someone else would not have been surprised in my shoes.
But, rightly or wrongly, reading my health insurance documentation feels to me like staring into the abyss. Indeed, I admit that the expression "clearly stated" provokes exactly the sort of dread I'm describing; it feels like the sort of thing a hospital or insurance company would say while sticking me with a massive unexpected bill.
Whether my reaction is reasonable or not, I can't say, but I do feel deep empathy for the therapists out there who balk at dealing with insurance companies.
That said, I was surprised when I mailed a bunch of bills to my insurer, and requested reimbursement. I figured I was probably wasting my time, but why not see what happens.
Anyway, they mailed me a check. The bills were higher than what my insurance would cover, but my insurance decided to cover a substantial portion.