Letters: Health Insurance Company Woes

The following letter is in response to the letter “Close Legal Loophole” by John R. Smith, published Oct. 18.

Mr. Smith offers a somewhat biased view of a reason for insurance prices to rise in healthcare. I would like to offer my opinion based on about 40 years in healthcare and my own personal experience.

Recently, my wife suffered an event which made it necessary to call an ambulance and a ride to the hospital emergency room. The ER physician ordered an EKG, and this is where what appears reasonable and prudent goes awry because somehow there is a coding error when it comes time for the bill and the health insurance company refuses to pay $42 for the EKG. The patient is in her 90s and is put into collections, not once, but twice!

Letters are exchanged between myself and the insurance company, and after only four months of “deliberation” by a special committee of the insurance company, the patient receives a letter from the company that, “You won!” The patient also receives a letter from the hospital stating that it no longer will participate with this insurance company.

“I won” somehow rings a bit hollow as victories go, but I can understand “how legal bills can pile up,” and if I sound less than sympathetic, it’s based on my experience!

Richard Nielsen, Royal Palm Beach