LETTERS: PROTECTION FOR THE INSURED

To the editor:

Recently I submitted a bill to my health insurance company for a service a hospital in California provided to my son. The insurance company booklet clearly mentioned that this particular service was covered, but this highly reputable insurance company indulged in several tactics to avoid payment.

First, the insurance company ignored the bill submitted by the hospital. When my son inquired, the company asked my son to provide a letter from his university to prove that he was a student. He complied immediately. He never heard from the company again. In the meantime, not hearing from the insurance company, the hospital started asking my son to make payments. Unable to get any results from the insurance company for six months, my son asked for my intervention, since he was insured under my plan.

I contacted the insurance company. The lady I talked to said the company was still waiting for proof of studentship. I arranged for a second letter from the university to be sent post haste and followed this with a letter to confirm it. Again, I didn't hear from the insurance company. I contacted it again and was told it needed medical information from the doctor. I arranged for my son's medical records to be faxed right away. I also had the hospital confirm the doctor's orders.

Several months passed without any reply. In the meantime, unable to explain the delay in payment by my insurance, I started making monthly payments on the hospital account. I kept calling and writing to the insurance company. I got two monthly statements indicating that the charges were "not covered" but the bill was being "processed." When I called to inquire, I was told the company wanted to talk to the doctor who ordered the service. The doctor was on an extended sabbatical in Europe. This was enough excuse for the company not to pay the bill.

By now it was over one year from the date of service, and I was still making payments to protect my creditworthiness. During this entire year, I hadn't received one single letter from the insurance company in reply to my numerous letters and phone calls.

Fed up, I finally contacted my lawyer. I provided all the proof he needed to back up my claim. My lawyer gave the insurance company 10 days to rectify the situation, or else. The hospital got paid within seven days. The case was thus closed.

This was not the first time I had been through this. I had a similar bad experience with another health insurance company several years ago. Again, only my lawyer's intervention got me the results.

This episode has raised many questions. Why did the insurance company not pay the bill until a lawyer got involved? Where they hoping I would give up in disgust? If there were treating me, a physician, in this manner, what could be the plight of the poor, disabled, uneducated or elderly? How many thousands of health insurance subscribers are out there right now going through what I have just been through?

In fact, I have heard from hundreds of my clients about their ongoing ordeals with various health insurance companies. This is a widespread problem which needs attention of all health insurance subscribers. I think it is times we organize a Health Insurance Subscribers Association to protect our interests. Either that or we submit ourselves to being abused by predatory and unscrupulous health insurance companies. What other choice do we have?

K.P.S. KAMATH, M.D.

Cape Girardeau