Mansell, Engel & Cole

Policyholders not the only parties that chafe under claim denials

Physician Michael Kirsch’s recent opinion letter to a national health publication seeks to make an immediate and starkly clear point. In communicating his views, the doctor is both candid and uncompromising.

Kirsch’s focus – wrath might actually be a better word – targets like a laser insurance companies that provide health care coverage. The descriptors he employs in a scathingly written piece render it manifestly clear that Kirsch and his professional peers are, well, put out with insurers.

In fact, they are infuriated. Kirsch is “mystified” by the illogic marking many insurers’ decisions. He underscores myriad insurance company outcomes as “real-life medical absurdities.”

And he adds this cutting comment: He states that appealing an insurer’s denial of treatment he has recommended “is just as smooth and stressless as calling the IRS for questions on your tax return.”

What is at the gist of Kirsch’s notably strong opinion letter written for MedPage Today is his obvious concern with the adverse effects that routine coverage denials have on his valued patients. His piece centrally implies that, while he can deal with the routine irritations and communications linked with MD-insurer interactions (albeit with difficulty), many people urgently needing his help cannot. For them, the games that insurers play are sometimes -- and quite literally -- life-and-death affairs.

That needs to change, he says. A system designed “so that physicians and patients simply give up” must be materially revised.

Oklahoma policyholders with questions or concerns regarding arbitrary claim denials or delay can contact a proven pro-policyholders’ legal team for advice and, when necessary, diligent legal representation.

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