Anybody Know Legalese?!?

Dennis Putnam dap1 at MINDSPRING.COM
Thu Jan 13 16:14:45 MST 2000


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At 04:41 PM 1/13/00 -0500, you wrote:

Don't know legalese but why should that stop me? :-)
My opinions of the harsh reality of free enterprise.

>  SNIP
>The nurse at the clinic told me that what they are doing is illegal.
> Does anyone know if such is the case, and if so, what law makes it
>illegal?  I was under the impression that no insurance company can
>deny medications if a doctor prescribes them.  I need to know which
>law covers this issue, so I can have some ammo when calling the
>insurance company.

This paragraph is misleading. The insurance company has no authority
to deny anyone anything except coverage. In spite of anything the
insurance company says, you can go into any drugstore, with the Dr.'s
perscription, and buy it. What the insurance company CAN do is refuse
to pay as long as it is in accordance with the contract underwhich
you are paying premiums.

>
>My doctor refuses to call them, talk to them for 15 - 20 minutes
>answering questions, and fill out all there silly forms, just to
>have the insurance comany do what he has already decided is best for
>his patient (me).  I don't blame him.  He doesn't have time to sit
>and answer a bunch of
>intrusive, presumptuous questions.

Tough donuts, unfortunately. If the insurance wants that information
to pay your costs for you they can have it. I'm sure you will find
some weasel words in the contract that says such. If your Dr. refuses
to provide it then you can accept that or look for a more cooperative
Dr.

>
>Insurance companies are getting out of hand on this one.  This
>particular one, acc. to the nurse, has even denied meds for cancer
>patients there at the clinic.

Insurance companies are a busines to make a profit not provide free
welfare. It does what it must to make the profit it deems
appropriate. This is free enterprise. Don't like it? Find some other
coverage or pay yourself. The blame for this entire mess is twofold.
Unconstitutional government intrusion into that industry and the
expectation of Americans to have someone else pays for goods and
services they receive. The introduction of 3rd party payer systems
was the start down hill for medical services.

>
>Any help you can provide would be greatly appreciated.
>

In this country the only help you can be sure of is that which you
give yourself. However, collectively we can also spend time shopping
for better pricing which will encourage the natural spirit of
competition. As long as we let a 3rd party pay without caring if we
are getting the best deal then we suffer the consequences.

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Dennis Putnam                   Public Key can be obtained from:
Loganville, Ga.                 <http://www.geocities.com/Heartland/Estates/8573>



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