Very early in my career, I worked in a position where patients would come in with prescriptions for orthopedic devices from doctors (knee braces or shoe inserts). These were custom fabricated items and they cost several hundred dollars. Patients would be fitted with these devices and then call back later angry when they found out their insurance would not pay for these items. So what would happen? We would have to "comp" their bill, i.e. give them their device for free. Very unfortunate. We looked like bad guys....like we weren't on the "up and up". Especially when their doctors told them this would be covered.
Why would the doctor lie to them? Easy....the doctors didn't know they were lying to their patients. There was a time when patients paid 20% of any bill and insurance paid the outstanding 80%.....of anything. That was the beginning of the end of that system. And that was the true beginning of my "advocacy"........
I felt the real problem was people did not have the information they needed to make an informed decision. So I created a form which explained how people could get accurate information about whether or not THEIR insurance would cover the service/device prescribed. The result? We stopped having to give devices away and stopped getting angry phone calls.
These days, I feel that insurance has become so complicated, it's hard for anyone to understand it. And I'm convinced that insurance companies use that confusion to their advantage to save themselves money by denying claims. I like to say that I "hold insurance company's feet to the fire" so that procedures/tests get approved and paid for. You paid your monthly premium, they need to cover your medical costs. Fitzpatrick Advocates will see to it that they do.
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