Like many people, I'm trying to convince my health insurance company to pay for something for which it doesn't want to fork over cash. I don't completely blame Cigna; the bill sent by the provider is outrageous. Then again, as a third-party payer in a mess of a health care system, the company is part of the problem of distorted incentives and rising costs. Sometimes lost in the debate between advocates of a market-based health care system—which we don't have—and true believers in a fully government-controlled system is that divorcing patients from responsibility for paying for what they get is a huge problem whether bills are ultimately picked up by insurance companies or government agencies.
In my case, Cigna doesn't want to pay $4,000 for a week with a Holter monitor (external electrocardiogram) prescribed because, after I turned 50, my warranty ran out. Such is life. The reason the insurance company cites for not paying doesn't matter. I know from my wife's experience as a pediatrician and from speaking to other physicians that insurers—whether private, Medicaid, or Medicare—issue refusals on the assumption that some will never be appealed and so result in cost savings. Pushing back usually achieves results, and I'm confident that I'll prevail in the end.
