Have you noticed that insurance companies denying medical treatments and prescriptions is closely aligned to the time of year? For example, getting a treatment or filling a prescription in February is no problem. When you go to get the same treatment or prescription in November your insurance company denies the claim.
The frustration is of course high when medical treatments or medications are denied by your insurance company. There is a logical reason for what seems like irrational behavior by your medical insurance company. The reason is your medical deductible.
Medical Deductible
The medical deductible is the amount of money you pay out-of-pocket before the insurance company is on the hook to pay. Once you have met the medical deductible amount the insurance company is responsible for paying all or part of the bill. The contract, the insurance policy, defines the amount the insurance company must pay.
Late in the year you are likely to have already paid the full amount of your medical deductible. Therefore, the insurance company must pay part, or all, of the cost. The benefit to the insurance company of denying claims late in the year is that you might not get the treatment or prescription until early the next year. Early the next year you will need to pay the full amount since you have not yet met your medical deductible for the year.
Historically this issue has been primarily an end of year phenomenon. However, the current medical insurance environment is different from the medical insurance environment that we are familiar with. For multiple reasons, including conversion to Obamacare, more families are converting to new medical insurance plans. As your current plan approaches its end, plan for a six to eight week period where getting claims paid will be difficult. Planning for this will reduce the frustrations that go with the denial of valid claims.
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