Increasingly, a system based on a culture of professionalism is being comprised by a culture of commercialism. The reality of today s health insurance and healthcare service companies is to achieve an excess of revenue over costs while caring for the sick, ensuring profit for corporate providers, investors, or insurers. To do so, the company seeks to control variability with best practices, which emphasize what is effective and eliminates what is not. Typically, companies will use solid research to discover the best treatment for most people, but then apply this criterion to everyone. Occasionally, however, a person who differs from most people needs special treatment.
Illness is a very personal experience, and it is riddled with variability.
Sensible care may be denied or delayed. If boundaries between wise and unwise, needed and unneeded treatment were always clear, there would be little controversy or confusion. What is invaluable in resolving complex claims or denied treatment disputes, is purely and simply, your resolve. Understand that the insurance company has in place policies and procedures that guide employees in the handling of claims and treatment calls. You must negotiate through these administrative obstacles.