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I am an attorney very interested in the problem of health insurance in our country. There isn't much money in this line of work since all health care plans require mandatory arbitration if there is a dispute over a denial of a claim, but still this is a problem in search of a solution that interests me. For example, the proposal on the table right now for national health insurance is to accomplish universal coverage through mandatory purchase of insurance from private insurers. OK. That proposal sounds American since the insurers remain private. But what about coverage? Who is going to make sure the insurers don't take the premiums and then start cutting back on what they will pay for? Yes, there will be government regulation, and perhaps the creation of a National Department of Insurance. Still I think individuals who have this mandatory health insurance coverage may need some legal assistance to enforce their rights. I don't think the Federal Government will or can do it for us.
In any event, I'd be curious to hear what others think of their health insurance and typical health insurance problems. I see a long term care insurance issue below. Long term care insurance is nice thing to have, for certain, but the courts have yet to clarify what it covers. Here in California the majority of claims under long term care insurance are denied because the insurer claims the insured is not incapacitated enough. That's a lot of denials for what can be a very expensive insurance policy. On the other hand, if the insurance comes through for you in a time of need, then it can be a lifesaver and protection for a lifetime of savings, so there is no clear path. If you do have long term care insurance and your claim is denied, you should definitely seek legal advice as there is a need to clarify under the law what is covered.
Let's solve the problem of health insurance so everyone can have some security around this issue.
I have a good one for you! I have Medicare and Blue Shield. I am a State of California Retiree. I went to my doctor yesterday and when the nurse was doing her initial consultation I asked for a flu shot. I am "high risk" due to my age and a chronic breathing disorder and I should have the shot. She said the doctor had decided not to bill Medicare for flu shots and I would have to pay $30.00 out of pocket. I told her I had never paid this way, my insurance covers immunizations so i would decline the shot for now. I contaced Blue Shield and they said they would pay for it but my doctor would need to bill Medicare first and if they denied it Blue Shield would be happy to pay for it. I did some online research and one site said refusal to bill Medcare after initially accepting a Medicare patient could be fraud and this shoud be reported immediately. I contacted a help agency we have here locally and they said pay the $30.00 and consider yourself lucky, many doctors are refusing to bill Medicare because they don't pay within 90 days and the "government is broke." I can't wait to hear what a profession like yourself thinks of this situation. Thank you, Carol