It's happened to many of us: We need medical attention, something that reasonably should be covered by our health-insurance provider.
We send in the claim, but it's rejected. We appeal, or resubmit the claim, and oftentimes it's accepted.
That's annoying enough. But, as a recent fine of $600,000 handed down to Capital District Physicians Health Plan and an affiliated health insurer demonstrate, some companies are doing their best to make sure you don't appeal.
CDPHP's biggest offense, as stated by the state insurance superintendent, was failing to advise consumers on how to appeal claims that were denied. Either Explanation of Benefit notices were not provided or their information was inadequate.
The EOB, according to the state, informs consumers on how a claim is processed, the costs covered by the insurer and those that must be paid by the consumer, and the steps available to appeal a claim denial. Without this information, consumers are essentially disenfranchised from their deserved right and coverage. With insurance policies and law difficult enough for the lay person to understand, any attempt to withhold information must be dealt with swiftly and severely.
While CDPHP and other insurance companies are now on notice, we encourage people to be aware of and exercise their rights when making insurance claims.
{"Headline24"/}Right direction on grad rates
{"Body Text Edit"/}Many of our area high schools' graduation rates as of June 2007 were ahead of the state average is surely something of which we can be proud.
Area schools are working very hard to improve four-year graduation rates, and the innovative programs being used are quite interesting.
Cobleskill-Richmondville High School has a transition team of faculty members that helps students move from eighth to ninth grade. The school also offers a flexible schedule for students who might otherwise drop out and enter the work force when a parent loses a job.
That is a situation not uncommon to our area or the hard economic times of today, and Cobleskill-Richmondville should be commended for addressing the issue.
School officials at Cobleskill-Richmondville and Unatego schools said they're striving for a 100 percent rate. We know that is a high standard, but we wouldn't be satisfied with anything less. Of course, more needs to be done to reach perfection, as many local school officials said, but we believe they're headed in the right direction.
Lowering the dropout rate must be a top priority, and this goes hand-in-hand with improving the graduation rate. Both can be achieved by paying close attention to students' needs, providing direction and the proper tools, and working toward a solution as soon as a problem arises.
Print this story
E-mail this story
