Most of us have health insurance and assume that it’s designed to pay for our medical care, but what if, in reality, we are allowing insurers to dictate our medical decisions? With the constant barrage of news stories regarding increases in deductibles, higher premiums, limited provider networks, and reduced coverage as a result of new competition within the healthcare industry, is it possible that these entities are also trying to take control away from you—the consumer—when it comes to making decisions about your medical care? In this blog post, William Schantz discusses how insurance companies can manipulate your access to certain procedures or treatments by influencing the cost associated with them. We’ll look at how increased demand for services combined with tightening regulations has allowed for greater confidence when selecting an insurer. Finally, you will understand why a variety of options may be necessary in order for you to make informed choices about your healthcare needs.
Can Insurers Dictate Your Medical Care? William Schantz Answers
Yes, insurers can dictate your medical care to a certain extent, says William Schantz. This is because insurance companies are responsible for reimbursing you for the cost of your medical treatments and procedures, so they need to be able to control the amount of money they spend on any given claim. Insurance companies have different methods of dictating care, depending on the type of policy you have and the purpose of that policy.
For example, most health insurance policies come with networks of approved healthcare providers, who are allowed to provide services and treatments covered by the policy terms. If you choose to receive treatment from a provider outside this network, your insurance company may not cover it (or may limit coverage). This means that if you want your treatment costs covered by your insurer, you must stick to the approved network of providers.
Insurance companies also have different strategies for controlling costs. Some insurers opt for a “managed care” approach, where they negotiate with healthcare providers on pricing and limit coverage to certain treatments. Most insurance policies come with co-pays and deductibles that require you to pay out of pocket for some services and treatments. Some other cost control measures include prior authorization requirements, which allow insurers to review the medical necessity of a procedure before approving coverage, and utilization reviews, which assess how often certain treatments are used by policyholders.
In addition, insurance companies may set limits on how much they will pay for certain procedures or medications, as well as rules about when they will provide coverage for certain treatments. According to William Schantz, insurers may also “carve out” services, which means they will not cover specific types of treatment or services, such as experimental procedures or long-term care.
William Schantz’s Concluding Thoughts
Overall, insurance companies are responsible for the cost of your medical care, and they have the right to dictate what treatments they will cover and how much they will pay for them. Ultimately, it is important, as per William Schantz, to understand your policy terms and keep up with any changes that might affect your coverage so you can make informed decisions about your healthcare.