Why Insurance Companies Deny Payment

by Joseph Ramos, MD, JD

Why would an insurance company say they don’t want to pay for my care when I was involved in an accident that wasn’t even my fault?

This is a common question we get at Ramos Law and, unfortunately, insurance companies sometimes have reasons that are “questionable” for either denying or limiting payment of claims that should be reasonable following an accident. To answer the question of why an insurance company isn’t “paying what’s fair” following an incident where one person is injured through no fault of their own, it’s important to understand some of the basics about how the insurance companies view these types of situations.

First and foremost, insurance companies need to be seen for what they are – for-profit businesses. These money-making machines have many individuals with kind, caring hearts. That said, the insurance companies have steps in place to ensure they don’t pay any more money in accident claims than is absolutely necessary. What are some of these steps, you ask? Well, here are two big ones for you to consider if you are dealing with an insurance company on a personal injury claim: time with their patients, less bureaucracy, and more cost transparency,” notes Dygert.

1. DID YOU SEEK MEDICAL TREATMENT RIGHT AWAY? Following an accident, it’s common for people to think, “Maybe the pain will go away on its own in the next few weeks.” This thought is one of the biggest reasons insurance companies limit or deny the payment of medical bills. Their perspective is, if you weren’t hurt enough to go to the emergency room, urgent care, or doctor right away, then you must not really be hurt at all. Of course, this is ridiculous, but claims are flagged for this every day. Bottom line: if you are injured, get medical attention ASAP!

2. DID YOU HAVE GAPS IN CARE? That means: did you start treatment and then stop for an “extended period of time.” (This can be as little as two or three weeks, which makes no sense medically.) If so, the insurance company feels you must not be hurt because, if you were, you would receive ongoing treatment. Bottom line is get the treatment you need until your symptoms resolve or improve as much as they possibly can.

One of the main focuses of the series is the concept of direct primary care, which is a growing movement in the healthcare industry

Direct primary care eliminates the need for insurance and offers affordable, personalized care to patients

It also helps businesses provide affordable alternatives to their employees

Dr. Dygert's Healthcare Disruptor Reading List

The Price We Pay

Marty Makary

Unaccountable

$11,500 PER PERSON ON HEALTHCARE

“Direct primary care allows physicians more time with their patients, less bureaucracy, and more cost transparency,” notes Dygert.

Marty Makary

US Annual Average Exceeds Other Countries

Never Pay the First Bill

Marshall Allen

The statistics are alarming. One in five Americans owe medical bills that have been sent to a collections agency, and medical expenses are the leading cause of bankruptcy and financial devastation — comprising more than 66% of bankruptcy cases. In the U.S., we spend an average of $11,500 per person every year on healthcare, significantly more than any other developed country. Despite this, American life expectancies are decreasing, obesity and mental health problems are on the rise, and over half the adults in this country suffer from chronic disease.

This physician’s passion for fixing the broken healthcare system is evident in his dedication to educating the public through his YouTube video series. He hopes to inspire change and empower individuals to take control of their health and advocate for better healthcare policies. By raising awareness and offering solutions, Dygert is leading the charge in a movement towards a more sustainable and effective healthcare system in the United States

As the CEO of Pinnacle Advanced Primary Care, a direct primary care practice, John Dygert, MD, sees firsthand the struggles and frustrations patients face when navigating today’s complex and costly healthcare system. Dygert addresses the broken healthcare system in the U.S. head on with his new YouTube video series.

"The time for action is now, and this series provides a powerful tool for individuals to join the movement toward a better healthcare system for all," says Dygert.

“Education and awareness are key in helping individuals take control of their health,” Dygert says. “This series covers a wide range of topics including the cost of healthcare, insurance, preventive measures, and the role of primary care. We also dive into the importance of mental health and the need to address the stigma surrounding it.”

Dygert recognizes that the current trajectory of the U.S. healthcare system is unsustainable and the time for change is now.

If you are interested in learning more about the broken healthcare system in the United States and how to fix it, Dr. John Dygert's YouTube video series is a must-watch. He offers valuable insights and solutions that can help individuals take control of their health and advocate for change

Scan the QR code to watch the entire series

Catastrophic Care

David Goldhill

“Direct primary care allows physicians more time with their patients, less bureaucracy, and more cost transparency,” notes Dygert.

A main focus of the series is the growing movement within the healthcare industry of direct primary care. Benefits of practices like Pinnacle include more personalized, affordable care for patients, without the need for insurance. It also helps businesses provide affordable alternatives to their employees.

Nexus of Care: Fulfilling the Promise of Employer-Sponsored Health Centers

Phillip Berry

An American Sickness

Dygert’s passion for fixing the broken system is evident in his dedication to educating the public. He hopes to inspire change, empower individuals to take control of their health, and advocate for better healthcare policies. By raising awareness, he is leading the charge towards a more sustainable and effective healthcare system in the U.S.

Elizabeth Rosenthal

If you are interested in learning more about the movement toward a better healthcare system, Dr. Dygert’s video series is a must watch. He offers valuable insights and solutions that can help individuals manage their health and advocate for change.

DYGERT’S HEALTHCARE DISRUPTOR RECOMMENDED READING LIST:

“Unaccountable” by Marty Makary

“Never Pay the First Bill” by Marshall Allen

“Catastrophic Care” by David Goldhill

“The Price We Pay” by Marty Makary

“An American Sickness” by Elizabeth Rosenthal

“Nexus of Care: Fulfilling the Promise of EmployerSponsored Health Centers” by Phillip Berry