I was reflecting recently how much I loathe the insurance industry after the WSIB (Workplace Safety Insurance Board) denied yet another patient of mine from receiving care in a legitimate claim. The reason provided to the claimant (not to me when I called) was that massage therapy was “to provide comfort” but had no rehabilitative value.
The claim was denied – despite the fact the employer paid fees to the WSIB in good faith to provide for its workers in case of injury. I suspect this is just one of many legitimate claims deflected and deferred by drone adjudicators not interested in the recuperation and well-being of claimants, but instead with mandates to save costs and deny claims if at all possible.
If the WSIB would release its claim-denial rates, I suspect the rates would be 40-60%. What’s more, I suspect insurance adjudicators routinely deny claims hoping a large percentage of claimants will give up and go away.
I suspect this is a tactic used throughout the insurance industry in whatever calamity the industry is promising to save us from – auto accident claim, workplace injury, life insurance, disability, mortgage or credit card repayment, home damage, etc. You put us at ease, promising to take care of us in time of worry. Well insurance industry, you fall far from your promise.
If I sound harsh, it is because I have a long-standing “hate-on” for your industry that arbitrarily, as far as I can tell, makes decisions that negatively impact and unnecessarily stress people’s lives.
Take auto insurance for example. Now, how did you convince the government that claimants in auto insurance cases should drain their workplace benefits (paid in good faith by employers) before auto insurance benefits are accessed? Why are employers forced to cover costs that have nothing to do with the workplace? As mighty as corporations and as influential as small and mid-sized businesses can be, they obviously don’t have as much power as you. These businesses against their will are complicit in your cost-savings scheme.
What other product or service can be sold without promise of delivery? If I buy a car or dry-cleaning service, a pair of shoes, dinner at a restaurant, a health care service, I expect to receive what I’ve paid for. Yet your claimants can never count on receiving what they’ve paid for. You take their premiums and when a claim is made you put up your policies, stating why you can’t fulfill your promise. Why are citizens purchasing a service in good faith they can’t be guaranteed to receive?
I know I can’t currently dismiss you and have to find some way to work with you. I just wanted to tell you – as a health care provider who provides ethical and effective care to customers you are obligated to serve – that you suck.
Nothing gets my attention like a good rant! I enjoyed your article.
To the best of my knowledge, my clients have been spared their insurers’ rejection. It’s not surprising though because after several years of practice I have only had one WSIB case. I certainly have never turned anyone away because of their insurance arrangements. This market barely knows I exist.
Having followed your blog for a while I know that you have made it your mission to get massage a place at the table within the health care system. Whether it’s the consuming public, the referring physicians or, as you indicate here, the authorizing insurers it’s clear the battle is up hill. Massage therapy has a lot to offer. Keep going!