Mansell, Engel & Cole

A core reason why a health insurer needs to contractually perform

The United States has inspired both global awe and envy over the centuries of its existence, owing to its many protected freedoms and opportunities. People from countries across the world have looked at America as a bastion of hope and enduring upsides, across multiple dimensions.

Not so much health care.

In fact, and over the course of recent years, the country’s health care system has been looked at quizzically by residents from many other nations. On the one hand, they see a country that is seemingly possessed of incalculable resources and wealth. On the other hand, though, they see that same nation holding out to its citizens a medical system that is so prohibitively pricey that millions of people fear to even engage with it.

A recent in-depth media piece on American health care costs addresses that puzzling and seemingly intractable phenomenon. The publication Atlantic notes that medical debt in the United States is a burden that is “unfathomable in many other developed countries.”

We know that our readers in Oklahoma and elsewhere understand that expressed sentiment, given that they know fully well – and often from a closely personal perspective – just how pricey their health care is. The Atlantic notes a recent study underscoring that bankruptcy is not an uncommon outcome for individuals and families facing stark health care-linked financial challenges. Research conducted by the Consumer Financial Protection Bureau reveals that “medical bills are the most common cause of unpaid bills sent to collection agencies.”

Such realities render it imperative that insured policyholders complying with their contractual duties be responded to in good faith by insurers also tasked with doing the same.

Put another way: It is both unethical and unlawful for an insurance company to purposefully delay, underpay or deny payment outright on a claim that is legitimately presented by an insured. Given the financial stakes described above, an insurer’s bad-faith conduct can easily yield catastrophic financial consequences for an insured individual or family.

“Medical debt is a uniquely American phenomenon,” states the Atlantic. That shouldn’t be similarly true concerning insurers’ malfeasance in responding to policyholders’ claims.

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