People purchase health insurance for the purpose of managing unexpected economic loss resulted from medical sufferings. In today’s medical field, many patients and physicians feel frustrated and powerless when a Managed Care Organization (“MCO”) refuses to pay for treatment, often because the insurer is playing a game of denial, delay and deceit to help the company avoid issuing big outgoing paychecks. Allegedly, private insurers are making payment decisions rather than medical decisions. This creates an issue because the denial of insurance coverage is often equivalent to a denial of medical care to the patient. The beneficiaries, of course, can always visit a different doctor not covered by the insurance policy if the insurer denies their claims, but this would be at the beneficiaries’ own cost, and most people cannot afford the huge expense.
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