An insurance company is not a charitable social service organization. An insurance company is a business. A business like any other, providing services for compensation in order to produce profits for their shareholders. The higher the profits are, the happier the shareholders are. Higher profits also mean higher compensation packages for upper management.
How do insurance companies increase their profit margins? Some of us might like to think that increased efficiencies and systems that benefit customers would somehow translate to increased profits, making everyone happy. This, of course, is not the case.
Insurance companies make profits by refusing to pay medical bills for sick people. Let me reiterate: Insurance companies increase profits by rejecting claims made by the sick people they ‘ensure.’ They are not some wonderful organization filled with compassion and the will to do good. They are companies that make more money every time they turn down a request for payment. Gramma gets sent home even though everyone knows she can’t take care of herself in her current condition – insurance company profits go up. A child needs an expensive medication to treat a devastating unusual disease – the insurance company says that medication is not on their approved list. Profits go up.
It’s important to remember this basic concept when dealing with insurance companies. Their goal is to pay as little as possible. So your goal as a patient or patient’s caretaker is to fight like hell to do whatever you have to do to force them to pay more. If, for any reason, you are not able to fight, you lose. You must do whatever you have to do to find someone who can fight for you. Phone calls must be made. Appeals must be filed. Internet research must be done. This is not easy. And it’s not simple. And it’s not good for your nervous system (says she who just received a 6pm Sunday evening phone call notifying her that her latest appeal had been approved and therefore her husband, who can not walk, among other things, will not have to go home tomorrow). You’re seeing it as an important health issue. A life and death matter. The insurance company is seeing it as a profit and loss chart.