The coverage is transparent

2013

I read this in the Jul 1 WSJ:

The quality of the coverage is transparent, so you know what is covered and that you can count on it, without having to worry that your coverage will end when you need it the most,” said Joanne Peters, a spokeswoman for the Department of Health and Human Services

It is certainly true that health insurance now must be provided under numerous new mandates and underwriting requirements. But that does not mean health insurers are handing a blank check to health care providers. There will still be requirements for the medical necessity of treatment. That could mean as it does today, some care could be denied or limited. Higher co-pays will still apply when it comes to certain brand or non-formulary drugs. In addition, in order to receive full benefits such as no co-pay wellness services, or the standard coinsurance, in-network providers must be used.

The point is, the much publicized reining in of insurance company practices is creating unrealistic expectations among some Americans. To have any chance of obtaining affordable health insurance, claims must still be managed for medical necessity, appropriate utilization and cost effectiveness and that means not every claim submitted will be paid with no questions asked.

If that were the case, there is a virtual guarantee health insurance will not be affordable. The fact is managing the cost of health care and the premiums to pay for that care is a partnership among patient, physician and insurer. They all must work together; no party is the enemy.