I often wonder if anyone is reading what I write in this blog, but when I write about insurance companies I’m pretty sure someone will see it. Thankfully, someone at Golden Rule Insurance did see what I wrote yesterday and called me to say that the problem “Alonzo”, a Golden Rule client, was having was all a mistake, or a mis-communication. His policy does not have a six-month waiting period for any treatments or conditions because it is a HIPAA policy. And cancer treatment is never excluded or delayed.
Yesterday I wrote about “Alonzo” (not his real name) who got a health insurance policy from Golden Rule Insurance through HIPAA (the Health Insurance Portability and Accountability Act of 1996). This federal law allows people like Alonzo to get insurance even if they have pre-existing conditions - if they have had group insurance which they have lost, and have no other option for health insurance. The law was designed to prevent people from becoming uninsured when they lose group coverage – as long as they can afford the outrageously high premiums that come with HIPAA policies.
When Alonzo’s cancer doctor’s office called Golden Rule to check on his insurance coverage, they were told Alonzo’s policy would not cover treatment for his prostate for six months. Alonzo was shocked and dismayed (as was I). But as it turns out, the Golden Rule representative gave the doctor’s office incorrect information. According to the Golden Rule public relations person who called me, there must have been some misunderstanding. Perhaps the Golden Rule representative who talked to the doctor’s office staff did not understand that Alonzo had a HIPAA policy, which meant there would be no six-month waiting period for any and all treatments. As well, the Golden Rule representative may not have understood that Alonzo’s treatment was for cancer. Apparently, there is never a waiting period for cancer treatment.
The Golden Rule public relations person who called me was very nice and very sorry that Alonzo had had a negative experience with Golden Rule. She said the company was experiencing very high call volume from clients, and that might explain the long wait to talk to someone. And perhaps this also led to and a mis-communication about Alonzo’s policy.
As I am in the insurance business I can appreciate the Golden Rule explanation – if I give them the benefit of doubt. Health insurance is very complicated. There are dozens of health insurance companies and hundreds of different policies. Doctors’ office staff spend a lot of time figuring out if their service will be covered, how much they will get paid, and what prior-authorization is required – details that are different with each insurance policy.
Figuring out how your health insurance works can be daunting. Not having insurance can be devastating. I told Alonzo I was exhausted after spending the day trying to figure out how to get help for him and worrying about whether or not he would get the cancer treatment he needed. Now imagine how Alonzo felt!