insurance company's

[Guest]

dont they piss a guy off!!! my wife has been going to therapy to try and keep the muscles in her neck and chest stretched out so she doesnt have problems breathing, today they told her that the insurance is going to quit paying because they dont think its necessary , just who is in control in this country the doctors or insurance companys

 

[Guest]

Your story is far from unique, unfortunately. I could tell stories...

 

[Shy Tall Guy]

just who is in control in this country the doctors or insurance companys

Hopefully neither one is in control - you are supposed to be in control. If the insurance company thinks the therapy is unecessary and you think it is, tell them you are going to contact your state's insurance comissioner - then do it. IF that doesn't work, then get a lawyer.

Ultimately however, the insurance company has a contract with you that says they will pay for certain covered expenses, and you (or your employer) will pay the insurance company so much a month given your risk of incurring those expenses. That is how they make money and that is how you reduce your risks.

The insurance company is not responsible any and all medical expenses you may incur, nor are they responsible for any and all therapies you wish to undergo, whether they are necessary or not - only those treatments they said they would cover. Think of an insurance policy as a wager with someone who is betting that you will not need treatment, and you are betting you will - do not think of insurances companies as someone who is watching out for you - that is your job.

Just the same, most insurance companies often try to welch on their bets, and have doctors and adjusters in their employ review case files that are costing them a lot of money, that output opinions that say a treatment is "not medically necessary" - always in favor of the insurance company. Talk to your doctor about how to combat this. If your insurance is through your employer, and your employer is sympathetic, have them go to bat for you with the insurance company; a few words from someone who has the say over whether the policy is renewed for a hundred or a thousand employees, often works wonders.

Ultimately though, it is up to you - if you can't get the insurance company to pay, pay out of your own pocket.