Understanding Health Insurance Coverage – Part 3
In Part 3 of our 4-part series on everything “health insurance”, we’ll look at a less discussed health insurance option: PPOs, or Preferred Provider Organizations. This edition of our series will help to provide a better understanding of the choices behind selecting a PPO, and what’s provided under this type of coverage in comparison to the previously discussed HMO coverage of Part 1.
As a brief refresher, in Parts 1 and 2 of our Health Insurance series here on the Blog, we fully established both health insurance terminology (from “authorization” to “providers” and everything in between) as well as the clear differences that separate Medicaid and Medicare coverage. Both of these investigations were important to lay out for our readers both transparently and truthfully, as many if not all insurance companies won’t tell injured accident victims or those will life-threatening illnesses the truth.
Over the course of various articles here on the Law Resource Blog, we’ve provided our readers with the facts insurance companies attempt to hide from beneficiaries, despite their right to receive the care they need on the road to recovery.
After an accident, legal counsel is absolutely necessary to navigate the often overwhelming, unfair practice that is dealing with insurance companies. A board certified lawyer with years of experience will know the best way to provide both the maximum compensation and necessary medical treatment his or her client needs.
Pain takes priority, not profit
When it comes to healthcare coverage, many Americans these days will find it cost prohibitive, and often won’t receive the care they rightfully deserve as they simply cannot afford the high cost of staying healthy. After an accident, medical expenses increase exponentially, leaving victims in debt or in pain, and sometimes both. Often enough, the option of acquiring a PPO or preferred provider organization style healthcare plan is not in the price range a person out of work, suffering from longterm pain can afford to invest in. However, there are multiple options for acquiring a cost effective PPO–the insurance companies attempt to hide this information, but we’ll now explain it in detail.
When it comes to PPO, the choice of physician, hospital, and pharmacy is there for the patient–for a price–and often an unfair one. For a steeper premium than an HMO, those who wish to select their own doctors and not become limited by a choice that must remain “in-network”, a PPO may be the right option. But under what circumstances? Insurance companies do not play fair with those who need care the most.
While it’s a deeply personal choice to make for those injured and seeking care (and should always be made after receiving advice from professionals with the details specific to a client’s situation), a PPO may be useful in the event of an injury that causes extreme pain, such as CRPS (Complex Regional Pain Syndrome).
In the instance of a CRPS (formerly known as RSD) diagnosis, the number of physicians available to provide treatment for the level of pain caused by this type of injury is larger, and therefore the patient may find a more thorough level of treatment available to them. When fighting on behalf of a victim suffering from extreme pain caused by CRPS, an experienced lawyer will always attempt to seek the maximum compensation owed to them, thus allowing the client to afford the medically necessary treatments that may only be open to them through a PPO, where the selection is wider and the treatment options more expansive.
Preference or priority?
Often, selecting a PPO is not a preference at all. For those dealt the pain and suffering of a diagnosis such as Complex Regional Pain Syndrome, it’s often a priority that they select the insurance coverage that will best provide them lifelong care. As we’ve explained in the popular CRPS Victims Are Suffering Physically, Financially After Medical Malpractice article, those diagnosed with CRPS don’t merely suffer from physical pain, but the financial insult to their lives can devastate them and further cause feelings of depression and isolation. Lack of resources, namely financial ones, can leave victims in pain so horrific that the suicide rate for the illness is higher than the rest of the population.
When a lawyer fights on behalf of a client suffering from chronic pain (CRPS being the most severe, life altering pain diagnosis a victim can receive) they always bear in mind the financial injury suffered by their client. In cases of CRPS, an experienced lawyer may not settle the case during mediation as they know their client deserves far more compensation than is being offered. It’s often necessary to go to trial and continue to fight, and a lawyer who’s familiar with CRPS cases will go the distance for his or her client.
Playing fair with PPO
When it comes down to it, HMO coverage may be more cost effective financially, but the restrictions placed upon those who need medical treatment the most are often unfair. PPO, on the other hand, can be unfair in the financial sense. When premiums become cost prohibitive and therefore cause victims to forgo the proper treatment, they may suffer lifelong complications from untreated medical conditions or injuries. Injuries or illnesses that occur after an accident are very often unforeseen, and therefore many victims are not financially able to bear the cost of those medical expenses.
That’s why it’s important to seek the most experienced legal counsel. The compensation obtained on behalf of a victim can and must provide for them for the rest of their lives, especially when their post-accident medical history includes a CRPS diagnosis. The lifelong pain and suffering of those who have been told they have Complex Regional Pain Syndrome is unimaginable to anyone who hasn’t been in their shoes. The treatments for CRPS is often highly limited, or extremely expensive. Currently there is no cure, and the disease must be managed indefinitely, for the rest of the victim’s life.
While we’ve used CRPS as an example within the context of this article, there are numerous other diagnoses that cause great pain and suffering, and can be financially devastating to a victim after an accident or in the case of Monsanto’s Roundup, terminal. A PPO can provide access to more experimental and/or life prolonging care to those diagnosed with the rare form of leukemia found in agricultural workers after being exposed to Roundup.
In conclusion, we must stress that selecting health insurance is a personal matter that must be given great care. An accident victim or those involved in Class Action litigation surrounding talcum powder, Roundup, and Gadolinium, and similar situations should always consult an experienced legal professional before making any decisions about their illness or injuries. Doctors and lawyers with knowledge specific to a case are the best and only people that should ever advise a victim of the next steps they should take on the road to physical and financial recovery.