In Healthcare, obeying the law is ethical but the two are not the same. When dealing with insurance companies, agents can stay within the written law but still act unethically. (Sherman, 2017). Insurance is an essential product that most people need to survive and get the care they need to remain healthy. All individuals and even businesses rely on health insurance to protect them as well as get the best quality medical care. Most individuals do not think of health insurance in a positive light. (CommonWealth School of Insurance). When planning on choosing health insurance, whether it be from an employer or through the marketplace, it is always hard to know if that insurance company is looking out for all individuals. The fact of the matter is that insurance companies always look out for their best interest more so than individuals or businesses. Whatever can make money fast without losing money. For example, dental insurance not covering a crown that has already been completed on a patient.
This insurance company stated the patient’s tooth was healthy enough for a filling instead of a crown and now this patient owes in full for this treatment. Insurers often act unethically when it is time to pay out patient’s claims. (Sherman, 2017). Individuals and Employers/Businesses pay so much out of pocket for coverage and then these insurance companies get to decide what they feel is necessary to pay without being that doctor or dentist who medically diagnosed them. How can an insurance company look at a specific claim and deny it when they have no doctorate in that field? This is a revolving ethical issue. When choosing the right coverage, it is important that you look at reviews on that insurance company from actual individuals who have coverage.
These insurance agents are out to make a quota, so it is important to also ask specific questions that help decide. These agents should know the field they are working in so they studder or cannot answer, ask for a supervisor. Customers depend on an explanation of their options and take advice. They owe an ethical obligation to the people that they know their own products. Sometimes, they have some insurers who are unethical and could be having a bad day or new to the insurance industry. Instead, some insurers just want to meet that quota and be done with the day. In a situation, agents in healthcare insurance and dental insurance use their expertise to push policies that bring in the most money even if the customer only needs a basic plan. This is legal but unethical as they are not looking out for their customers. For example, and elderly women needed just a basic dental plan. The dental insurance company sells her a plan that only covers children under a certain age.
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This woman has no clue until she goes to see a dentist and they tell her she owes in full due to her dental insurance only being a pediatric plan. They can take from the misinformed and use this to sell insurance that do not quite qualify for these customers. This could eventually harm the insurance company in question if it happens too many times. They can get negative reviews. This example is legal by law, but unethical. Not all insurance companies are like this though. Individuals buy insurance in hopes that they may not have to use it but have protection if something were to happen. A specific ethical challenge within the insurance profession is redlining. Redlining is the practice of accepting or denying coverage of certain policies based on current health conditions. (OpenText 2018).
Some individuals will have a higher premium than others due to the current health conditions they have been diagnosed with already. The code of conduct for insurance companies should be to place the interests of the customers first. They should strive to maintain a professional level as well as know the laws and rules of the insurance business they work for in that state. Not all insurances are looking out for their customers and cause an ethical issue for many to face. There are also ethical issues in state-funded insurance. There are criteria that you need to pass to be considered for it and most people cannot afford medical or dental coverage.
A single mother who is working two jobs to support her two kids does not qualify for aid as she makes too much in their eyes. This same woman has trouble feeding her children or paying rent and now needs medical coverage she can not afford. This is ethically wrong. Individuals who do not work qualify for more help than those who try to work. To conclude, when deciding on an insurance company for coverage, look at the reviews as well as talk to someone who knows what they are talking about. Do not jump the gun so to speak and choose insurance just because it sounds good. It could be too good to be true so always weigh out the pros and cons of many insurances before choosing one. Look at the ethical and unethical issues concerning each one to decide. Insurance is a necessity for most and choosing the best option is crucial.
