Ed C.’s Post

A recent WSJ article reveals widespread exploitation in health insurance enrollment, affecting low-income Americans. This news made me feel ill. Key issues: • Misleading social media ads luring vulnerable individuals • Unethical brokers and insurance companies profiting from the situation • Inadequate oversight from government agencies, despite good intentions The greed of these companies and individuals profiting off people in compromised situations is appalling. It extends beyond "brokers" to health insurers who incentivized these behaviors. While CMS likely aimed to help, their lack of controls enabled this exploitation. I hope those taken advantage of have strong support networks to help them recover. As open enrollment approaches, I urge everyone to: - Carefully review all insurance offers - Verify the legitimacy of any 'too good to be true' deals - Seek help from trusted advisors or official government resources This is an opportunity to choose the right health insurance plan. Please help your aging loved ones find the right plan for them. https://lnkd.in/gGmBmHXk

I see so many therapists and clinicians on here complaining about not being able to keep full caseloads or make money. Look: the reality is that most Americans have health insurance and prefer to use it for their medical care. If you refuse to learn how to navigate the insurance system and rely solely on out-of-pocket clients, you will probably continue to experience low caseloads-- particularly during a time when many people are feeling financial anxiety. Yes, the system is broken and it is a nuisance. Yes, it eats up our time and can be frustrating. Yes, we sometimes need to fight with insurance companies to get properly reimbursed. BUT if access to services is important to you, then denying clients the care they desire because you're taking a "stand" against insurance companies is neither productive nor effective. Without going through a tech company or MH platform, you can learn how to navigate the insurance system, which will make your services more accessible and bring you more consistency with your caseload. Yes, it's unfair and not a good system BUT if you neglect 75% of the market, you simply can't be surprised if you're not bringing in the number of clients you'd like to.

What are the biggest misconceptions about health insurance? They pay the bills. They provide protection. Wrong! Read about it on our latest blog and many thanks to our friend Dean Jargo for his contribution. https://lnkd.in/gZ3yv6uC

In its latest regulations that came into effect on April 1, 2024, IRDAI the insurance regulator removed the ceiling of 65 years for a person to buy a health insurance policy. It asked insurance companies to offer health insurance products to all age groups. Buying a new cover for a senior citizen requires a full medical checkup and all the pre-existing conditions are checked. Insurers can reject a cover if the underwriting process shows high risk based on current medical condition. As insurers will evaluate the profitability for selling senior citizen plans, even after the IRDAI directive, stringent terms and conditions, exclusions and very high premiums will continue to be a reality. Senior citizens may have a longer waiting period before being able to claim treatment cost of certain medical conditions. Better consult a Financial Planner and start putting in money periodically to form a Medical Emergency Fund.

health insurance: 15% overall rate to the roughly 3 billion claims processed nationwide each year suggests that an estimated 450 million claims per year were subjected to denials. (https://lnkd.in/esFx52Sa) That's roughly 1.5 denied claims for each american every year. Young people don't get sick. In reality, for people who use health insurance, i.e people who are older than 40, it is probably 3 denied claims per year. Health suffering and financial ruin are the direct consequence. we want to do something about it. smartvisionhealth.com

Don’t know the specifics of this case, but it appears to me that the insurer declined due to absence of credible justification for hospitalization. The health insurance policy requires (1) diagnosis of some illness or disease which (2) requires inpatient treatment at a hospital. Unless these conditions are met, the case won’t move forward. Admission to ICU by itself is not a ground for the claim to be admitted, if it was for observational purposes. But unfortunately, health insurance has an affliction that insureds think of it as a free pass for getting hospitalization done. The challenge is to educate the insuring public and make them understand that it is not so. There are and will always be many entitled celebrities or people with social media reach, who are ignorant of how the policy operates but amplify negativity on social media about health insurance. They may insert a photo of theirs lying on hospital bed to generate maximum outrage. The insurance industry should seriously think how to counter such narratives effectively so that the image of insurance is not tarnished.

Too often when a person comes to us after suffering a catastrophic injury, there's nothing we can do to make them whole. There might be no insurance or not enough insurance. Or maybe health insurance company's reimbursement lien for the bills it paid far exceeds the potential recovery. We had a premises liability case where a young boy broke his neck in a fall. His paid medical expenses alone exceeded the available insurance coverage. We were able to settle the case in 2022 for $100,000, the insurance policy limits.  Since settling, Suzie Armbruster and I have been fighting the health insurance company, which wanted the entire settlement, to reduce its lien.  After 20 months of the company refusing to reduce their demands by a penny, we were able to negotiate a substantial reduction. After reducing our attorneys' fees by more than $23,000 and paying co-pays for medical treatment, we got enough money for a structured settlement to ensure that this child will receive over $58,000 once he reaches adulthood.   I'm proud of the fact that if we agree to represent a catastrophically injured client, we never give up on them. We see the case through, even if it means going to trial knowing we will likely never even get reimbursed for our out-of-pocket expenses, let alone paid. Some of our most worthwhile cases are the ones where we could have walked away, but we stayed and fought because it was the right thing to do.

"Providers in ghost networks"....Are you a provider with this particular issue of insurance companies adding you in ghost networks?" Well over many years we as a group of providers in network with insurance companies go through the challenge of "prooving our in network status", almost yearly or less than that. Even after activations of ACQH's, showing proof of our contracts...Which causes us the providers to look at health insurance MCO's as a major JOKE. I will continue to keep our clients/patients informed and definitely keep them aware every time MEDICAID MCO/Private in network insurance rejects their claim, even after they approve the services under a provider, clients should be always informed and they should also be calling their insurance companies and demand an answer (since us the Providers never get a real answer from insurance companies). It's a disappointing time with health insurance companies that continue to play with funding $ that is for the people, gambling 🎰 at its finest to their detriment. https://lnkd.in/gQXWZfGu

That's a clever way to emphasize the importance of buying health insurance! The idea is that: 1. *When you don't need it*: You might feel healthy and think you don't need insurance. However, unexpected medical emergencies can arise, and having insurance can provide financial protection. 2. *When you need it, you might not get it*: If you wait until you're sick or injured to buy insurance, you might be denied coverage due to pre-existing conditions or other factors. Buying health insurance when you're healthy ensures you're protected in case of unexpected medical expenses. It's a proactive step to secure your financial well-being and access quality healthcare when needed. This mindset can be applied to other insurance types, such as Personal Accident insurance.

Care Insurance - Unacceptable Claim Denial! I'm beyond disappointed with Care Health Insurance. My father recently suffered a transient ischemic (TI) attack and had to be hospitalized. Yet, when we filed a claim, Care Insurance shockingly dismissed it, stating that his admission was just for a "routine checkup," with no diagnosis – blatantly disregarding his serious condition. This isn't the first time we've faced these hurdles with Care Health Insurance. Each claim seems to be a battle, despite us diligently paying premiums from our hard-earned money, trusting them to provide security in times of medical need. Are we expected to go through the emotional and financial toll of hospitalization as if it’s a casual affair? Care Insurance – it’s time you honor your promises to policyholders. Insurance is meant for moments of crisis, not for companies to profit at the expense of people’s health and trust. Care Insurance Anuj Gulati please look into this