As someone that has had troubles with insurance companies, I can say that there are a lot of things that don’t make sense to patients or doctors.
And now that I’m doing an internship in the mental health field, I’m seeing a daily struggle with insurance companies to get people the help they need because insurance companies say “I know the treatment plan is x number of days, but we don’t think that’s necessary”
How can insurance companies deem treatments unnecessary or even cut them short compared to what health professionals consider necessary? Are they held to a certain standard or is it up to them because they’re a private business?
I understand that insurance companies themselves don’t stop treatment, but by cutting off what they’ll cover, they don’t leave patients any choice.
In: Other
Insurance is all about managing risk – if you offer a very generous policy that covers everything and anything without limit, you probably won’t make much money as you’ll always be paying for treatments. If your policies are too strict, then you still won’t make any money because you won’t have any customers since they will see it as a waste of money.
Trying to strike that balance between what is useful for customers and what is profitable to offer sometimes results in insurance companies deeming things unnecessary or placing limits on procedures.
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