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Medical industry concerns, care costs and patient challenges

On Behalf of | Mar 21, 2019 | Insurance Disputes

As an Oklahoma health care policyholder, you just want to be timely and fairly compensated by your insurer when you submit a valid treatment claim, right? It’s not rocket science. You duly satisfy your contractual obligations and rightly expect that your insurance provider will do the same. After all, it is happily taking your money.

Many millions of American claimants know that while that reciprocal equation is simple enough, its logical outcome is often thwarted by an insurer’s resistance to a claim demand. Our blog files at the established Oklahoma City pro-policyholders’ insurance law firm of Mansell, Engel & Cole are replete with posts chronicling bad-faith insurance company conduct. Many claimants reasonably believe from hard experience that is a typical default response for an insurance company to delay, underpay or deny outright payment on a legitimate claim.

A recent article spotlights a prominent patient safety group’s findings regarding top-tier industry concerns. We pass along a few key points, which will likely have an impact on future insurance costs and be key catalysts that sometimes drive insurers’ obstinate behavior in the wake of a treatment claim. The nonprofit ECRI Institute stresses these key concerns impacting patient safety:

  • diagnostic error and doctors’ stated frustrations while interacting with complex electronic health record systems
  • increased industry burnout
  • medication misdiagnosis
  • failure to treat relevant behavioral symptoms along with physical harms and injuries
  • lagging skills; professionals’ failure to continually learn
  • hospital-acquired infections

These varied factors provide fertile ground for patient injuries and claims, and are thus a focal point of insurers’ close scrutiny. Unquestionably, claims based on any of those bullet points will spur insurer blowback in many instances, resulting in the above-cited and often predictable claim delay or denial.

Patients do not ever need to let that happen or to enable such a frustrating process to ensue. There is one responsive track that an insurer needs to follow in response to a claimant’s legitimate payment demand, and it is marked by prompt and full reimbursement, not contractual bad faith grounded in evasion.

Questions or concerns regarding this important subject matter can be addressed to proven and aggressive pro-policyholder insurance law attorneys.