Many people find the idea of having a separate health insurance policy for critical illness somewhat of a paradox, given that they assume that a standard health insurance plan or policy should provide the necessary range of benefits and cover if an individual develops a critical illness.
The wide range of health insurance plans and policies available cover an entire scope of different health related situation scenarios and there are specific plans and policies that focus on providing a range of benefits specifically focused on what could be termed a critical illness.
The nature of defining a critical illness can be a difficult one and the policy wording should be carefully examined to see how the insurance company defines the nature of a critical illness.
There are often scenarios where an individual or even potentially a doctor could see an illness or health condition has been critical, where the insurance company would not. This is in part a contradiction that is inherent in the nature of health insurance and health insurance plans and policies generally.
Health Insurance Market
The way the health insurance market in the United States has developed means that the insurance companies have evolved a system whereby they effectively determine whether or not the patient can be treated either by a health care physician such as a primary care physician or any other health care provider or in hospital.
Health insurance companies use the phrase prior authorisation to effectively mean that they must give their approval to any procedure or intervention that an individual or health care physician wishes to undertake that they expect the insurance company to pay for under the terms and conditions of the policy.
The insurance company will have a right under the terms of the policy to determine whether any such procedures are deemed as medically necessary. This again is standard in all health insurance plans and policies.
It does however activate a level of urgency in relation to critical illnesses however they may be defined, simply because of the time demands and the severity of the illness that needs to be treated.
There is an inherently huge level of stress on the patient and the family and potentially on the health care providers that they have to get an insurance company’s approval to undertake procedures where a persons life or well-being may be at stake.
It is crucially important that there is some type of appeals procedure to challenge the insurance company’s decisions, both within the insurance company itself and by way of consumer protection at state and possibly federal level as well.
