Originally posted by: Patranus
I am advocating reading the policy before you sign up for it so that you know what is and is not covered. If the policy doesn't meet your needs than you should not agree to it and shop for another policy.
If you wait to find out your full scope of coverage until after you need your policy, you are correct that you might be in a hole but that hole is hardly the fault of the insurance company. However, if this is the case, the hospital cannot legally require life saving care so a financial obligation is in no way related to a medical necessity.
"Read your policy." Ah, I see.
OK. You, naturally, have read your policy. So how about a little test:
1. Your cardiologist proposes a nuclear stress test after your stress EKG reveals an abnormality (but there's no definitive evidence that there's blockage). Will your insurance company cover the additional test?
2. Your as-yet-unborn child is diagnosed with medulloblastoma when she's two years old; will your insurance company pay for a total resection + radiation therapy? (2a) How about if there's supratentorial spread? (2b) How about if the cytogenic profile has an amplification of MYC or MYCN?
3. How about if your child is instead diagnosed with an oligodendroglioma? What treatments will your insurance cover? (4) How about for a glioblastoma?
5. Your kid has Cystic Fibrosis? Will your insurance company pay for the drug PTC124?
6. You're diagnosed with diabetes. Will your insurance pay for the surgical implantation of an insulin pump? (6a.) If so, how about one with RF frequency communication?
7. You're diagnosed with amyotrophic lateral sclerosis. Will your insurance company pay for a speech-language pathologist? (7a.) If so, how many sessions will they pay for?
8. You contract hepatitis C and after several years, you require a liver transplant. Will your insurance company pay for it? If so, suppose you live with the transplant until you're 71, but then your body rejects it. (8a) Will your insurance company pay for a second transplant? (8b) How about if you're 80, but your in great physical shape?
9. You need bypass surgery. Will your insurance company pay for MIDCAB rather than conventional surgery? (9a) You're 88 and in great health; will your insurance company pay for bypass surgery at all?
10. You have moderate sleep apnea, which is mitigated by the use of a CPAP device. However, don't like using the CPAP, as it disturbs your sleep and makes you feel dependent on a machine. Will you insurance company pay for an uvulopalatopharyngoplasty?
Naturally, you got 100% on this test, because you checked all of these details - plus those for 100,000 other possible medical conditions - in the the "policy description" before you signed up. But I'm curious: Did the insurance company send you the full 40,000-page policy description, or just the 10,000-page condensed version?