Here is a fantastic example of how health insurance companies can hide behind technicalities and deny claims which have been made by the insured. This example should give everyone an understanding of why they should make it a point to understand the terms and conditions of the policy they purchased.
The kind of technicalities insurance companies are using to deny claims can at times be certified as atrocious. They can approve a claim for the repairs of a vehicle which they have insured but refuse to get the vehicle painted by claiming it is cosmetic in nature. We are discussing a similar issue that an individual is confronting after he had to undergo bariatric surgery to remove 500 pounds from his body.
Stanley Hollar denied help by health insurance companies
Hollar an individual from Rushville who was weighing nearly 700 pounds underwent bariatric surgery two years ago and successfully managed to lose 500 pounds. Hollar should have been happy with the loss but is being haunted even now by his days of obesity.
The bariatric surgery removed the extra fat on his body leaving behind additional pounds of excess skin that are continuing to restrict his movement. Hollar is also a handicapped individual who has lost his leg below the knee three years ago and is presently unable to use the prosthetic which was designed to fit his larger body of the past. Hollar has excess skin hanging on his body from just about every part and has led him to comment that his skin resembles a pair of MC Hammer pants.
Hollar is insured by private insurers along with Medicare but for some reason, the insurers have refused to approve the surgery for skin removal after the bariatric surgery by deeming it a cosmetic procedure. The denial by insurers has left Hollar with no options but to raise $25,000 to undergo skin removal surgery and purchase a new prosthetic that will be suitable for his leg because the old one is too large for him.
Is the decision by the insurers justified considering the conditions?
Experts have mentioned that many people who undergo bariatric surgery begin a struggle after the procedure because they need additional treatments which include surgery for removing the excess skin as desired by Hollar. Patients over the age of 30 who undergo bariatric surgery can rest assured they will be required to expect loose skin on their body.
The skin begins to lose its elasticity beyond the age of 30 and people who lose a significant amount of weight will begin to experience that their skin is just not recoiling. The excess skin on their body can create problems of the health which can include rashes and infections.
Over 50% of the patients that undergo bariatric surgery can benefit from surgery for reducing the skin according to the Obesity Society. One-third of all patients could be suffering from health problems and may need this procedure to remove the skin. Bariatric surgeons have claimed that the differences between skin reduction surgery and breast reconstruction among women that undergo mastectomies are minimal.
Surgeons believe that insurance companies are discriminating against poor people that may have suffered their entire lives. Insurers are making decisions on the spur of the moment without considering the needs of the insured. Quite a few patients that need bariatric surgery are unable to afford it financially despite coverage being offered by their insurer.
They are often required to pay high co-pays and deductibles which makes it impossible for them and potentially puts bariatric surgery beyond their reach. An incident of a patient spending $10,000 as out-of-pocket expenses despite having the necessary coverage is mentioned by surgeons as an example to substantiate their view.
Kind of actions that insurance companies should be taking
Insurance companies have a set of policies which govern them and they have no incentive to change the policies unless the administration passes legislation for the amendment. Unfortunately, patients like Hollar will need to wait patiently until a decision is taken by the powers that be to ensure insurance companies do not use technicalities to deny claims that are absolutely necessary.
Stanley Hollar may just be an example for insurance companies that are denying hundreds of claims by using technicalities. Insurance companies are known to interpret their policies differently and causing problems to countless numbers by denying claims without adequate reasons. It could be one of the reasons why people are scared of insurance companies and are often wary of them. Merely reading through the terms and conditions of the policy will not be entirely helpful for people unless they also obtain legal advice to understand the technicalities of the policies they have invested money in.