Why is it legal for an insurance company to deny life saving doctor ordered procedures?

Answer 1

It sure is. Many health insurances utilize "administrators" instead of doctors to determine whether certain procedures are necessary or effective. I don't know about you, but I'll trust my doctor before I trust some "administrator" sitting behind a desk.

Answer 2

First of all, they can't "deny" access to health care. All they can do is deny *paying* for it.

As we move more towards socialized medicine and see the lines at the clinic get longer and the time spent with a physician necessarily shorter (was anyone else in an HMO?), we can expect more of this. What will happen is that those with the means will buy supplemental policies or pay out of pocket, the rest will be relegated to whatever the government provides. This is the same government, by the way, that sponsors FEMA ...

That rant probably doesn't help you, but this may: most insurance companies have a review process for just this sort of complaint. If you're getting nowhere, there, most states also have an ombudsman.

Good Luck.

Answer 3

You think its bad now, just wait until Hillary gives us socialized medicine. Instead of getting denied, you get put on a wait list for as many as 5 years. Does ya alot of good if you desperately need a transplant or operation. The fact that it is legal to deny a person is because the health business(Big Pharma, and insurance companies included), is a big money business and they can deny claims that they deem experimental or if the cause of the illness is self inflicted. Socialized medicine is a nice thought but it is proven that it doesn't work well either! Fact is there are many natural cures that medicine doesn't want you to know about. Check out the link below for some great health remedies that do not involve medicine, or chemicals. Its a catch 22 system. Everyone gets sick and the money makers capitalize on it.

Answer 4

Cost.....since most of your insurance companies have HMO plans and are partners with certain providers,they can always find a doctor who can testify that the procedure was not necessary. Every insurance policy has an 'exclusions' section and it is part of the policy. It is always helpful to read this section beforehand to know just exactly what is covered and what is not covered. If there is a "Life Threatning" illness and there is only one procedure available to save someone's life, it can be pre-approved.

Answer 5

It's in the terms of the contract -- (the fine print) what is deemed "life-saving" is usually debatable or could be prohibitively expensive or possibly has a bad "cost/benefit ratio" -- like something might cost a million dollars and only keep someone alive for a few weeks.. or they might deny "experimental procedures" .they have several scenarios that allow they to deny coverage under the terms of a contract. Also, some contracts have maximum benefits cut offs.

Answer 6

A couple of reasons:
1. The procedure is experimental and not approved.
2. The procedure is illegal
3. The contract you entered in to with the insurance company specifically excludes that procedure.
4. Their doctors review the medical records and believe another approach has more merit.

Answer 7

It's not legal for insurance companies to deny a procedure. It's just legal for them to deny payment for a procedure.

The insurance business is a practice in cost-vs-risk, which seems awfully fleeting when a person's life is at stake.

Answer 8

I honestly don't have an answer for this, but once again it all comes down to money, money, and money.
Insurance is the largest scam that this country allows. The Government is more worried about Bill Gates and Microsoft instead of a company denying Heart Surgery because they have reached their "max" for the year (HMO) You pay life insurance, and they take their time giving you the money, instead they want to "invest" it for you. You pay car insurance for years with no tickets or accidents, one day someone hits you and your rates go up because you are now "accident prone"

Answer 9

Because insurance companies are in the business of making money not making people well unless it's cheap. Not saying it's the right thing, but it's the truth none the less.

Take a look at HMO's for example for many years people were saying how great HMO's were, until everyone found out the dirty little secret about shared risk pools. You don't see alot of HMO's around anymore.

Answer 10

Because successive governments have represented insurance corporations instead of the people.