Okay, I’m coming back in late (letting the floors dry), and I see iceweasel is claiming that insurance companies deny care.

Let’s look at that possibility in my own case.

In the last five years the only time that care has been “denied” is when I have gotten diagnostic testing that wasn’t pre-approved. However, with the doctor’s assistance, we were able to get approval after the fact. No problems there.

Back when my son was in rehab after the car accident that caused his brain injury, he had a tracheotomy that required specialized care. He finally reached the date when the trache was removed, and the insurance said that he could come home as the trache was gone. This was crazy, given his vast limitations caused by his injuries. When the insurance said they were going to stop paying for care after date X, we filed an injunction in court to stop them and prevent anyone from moving my son. Because my health care was covered by my employer, we had to file in federal court. The insurance acquiesced and said they would not force my son to leave while the case was in court.

The situation was stalemated for months as we went back and forth. At one point, the case manager wrote down that we were preparing for discharge, by which we meant that in case the court case didn’t go our way, we should prepare to bring him home. But the case manager didn’t write that: they just wrote, “preparing for discharge.” My lawyer said that we couldn’t support keeping him in the facility any longer, regardless of what that meant. We therefore had no choice but to take him out of his in-patient rehab and bring him home months before he needed to. The court case continued to be stalled for months, until finally the judge called both sides in for conference and asked what was going on. He finally stated that it was unconscionable that the insurance was making noises about not paying the bill.

The insurance company cut checks to cover everything the next day.

Lessons learned:

1. Case managers can be really great or can really screw things up.
2. The courts can handle cases of medical disagreements regarding care levels and insurance coverage.
3. Some insurance companies are better than others at coverage. I had no choice of my coverage when my son was injured; I do now. Thus the free market will weed out companies that don’t provide what they say they will. There is no requirement to mandate insurance coverage.