Insurance companies: scraped from Satan's colon

The BBQ Pit
1

I work at a hospital as an insurance biller. It is my job to make sure your claim is filed properly and paid according to either our contract with the insurance company or your policy with same.

I mainly work with one of the largest companies in the country (think of a crucifix the color of the sky). There are two ways for me to check on the 1500+ claims I am responsible for: if it’s a Georgia or Federal policy (combined represent about 70% of the claims), I can check the website. Very convenient. I can blow through several dozen an hour.

The other way is to call their service center. In the old days (last Thursday), they had an automated system that required me to enter the important information (policy number, date of birth, date of service, etc) via the telephone keypad. Again, very convenient. I have been doing this long enough that I have (had) a pretty good rhythm going and could knock out quite a few claims in a short time.

Then Friday comes. It seems the company decided that a voice recognition system would be better.

FUCKING BULLSHIT!

I have yet to encounter a VRS that works more than 20% of the time. It rarely understands what I say whether I use a normal speaking voice or whether I E-NUN-SEE-ATE the information. When it finally does, it asks me to verify what I just said.

Now, in the time it used to take to get information on 5 or 6 six claims, I now get just one. Most of the time I get transferred to a representative. After 5-10 minutes of hold time, I finally get someone and they are only allowed to help me with 3-4 claims at a time. Seems they have other providers to assist. :rolleyes:

I have made it a point to complain to every rep I talk with about this system. They ask that I give them time to get the kinks out. I don’t plan on living that long. Other companies that tried this system quickly abandoned it after hundreds of complaints.

Ultimately, this is just another stall tactic. Insurance companies are pure evil, folks. Don’t let their commercials sway you.

More evil:

In Georgia, we have a Prompt Pay law that requires EVERY insurance company doing business in the state to pay or deny a claim in 15 business days upon receipt of said claim. Excuses like repricing, pre-existing condition review, stop-loss review (for large claims) are not valid excuses for not paying the claim.

If the company has a contract with the facility, they can get 30 days, but if the claim isn’t paid within that time frame, the law reverts to the 15 days.

If your insurance company doesn’t have a contract with the facilty you are using, they will try to get a blind PPO discount. They shop around to see what contracted companies pay and try to use that discount thus saving you money, BULLSHIT! YOU aren’t saving a single penny. The insurance company pays these people a little so that they don’t have to pay the facility a lot. You’ll never see a dime of that savings. We don’t accept this and tell the insurance to pay per the patient’s policy or we will bill the patient for the balance. You’d be amazed how fast we can get a check.

We are flexible enough that we will negotiate a discount, but the companies rarely pay within the timeframe we agree on.

Well, there’s a lot more, but I had to get that off my chest.

Questions?

2

I once caused a customer service rep at an insurance company to quit her job. I excoriated her about their sleazy tactics, and asked her how she could sleep at night, know she was ruining people’s lives when they were least able to defend themselves. The next day I called regarding the claim, and I was referred to another rep who told me the first rep had resigned in tears.

My work is done.

3

But…but…Kaiser Permanente cares! About me! They even told me so in one of their commercials!

Ah, who am I kidding? Kaiser sucks cancerous rhinocerous penis.

4

If you think insurance companies are by definition evil, you could always put your money where your mouth is and go through life without any insurance at all. The fucking problem with the fucking system is losers who think that they are entitled to 100% coverage for anything they think of at the time for little or no premium and then whine when they don’t get it. The fucking problem with the fucking system is doctors and hospitals who try to charge exorbitant prices for routine care claiming it “doesn’t matter because the patient has insurance”, and then bitch and whine when the insurance company says that they are not going to pay $10,000 for a 20 minute appendectomy. The fucking problem with the fucking system is that we are all of us, every one, picking up the tab for care of those people who don’t carry insurance, yet demand (and by law are given) expensive care with no intention of ever paying for it. The fucking problem with the fucking system is voice recognition phone systems because I hear ya brotha, those things drive me crazy too.

5

No, the fucking problem is that we have allowed a powerful group to put itself between us and the people who actively work to provide us with healthcare. The fucking problem is that these people have a financial interest in denying healthcare to people.

That bears repeating. Let me say it again.

Health insurers have a financial interest in denying people access to doctors. In their ideal world, everyone pays in and they pay nothing out. This is what is commonly called “evil.” They take in more and more money and pay out less and less money so they can keep the rest. The entire health insurance system should be dissolved and the companies broken up. They are parasites. They are extortionists. They have blood on their hands.

6

That about sums it up. Thanks.

That said, we could always try a little harder to make sure our customers understand the 900 pages of legalese they’ve been paying for–gets me a LONG way in handling a claim when I can get that done.

Of course, Health insurance is mind-bogglingly complex for the reasons WD pointed out as well as a few others which further complicates the whole expectations/reality picture… blah blah blah blah…
Voice recognition systems positively slurp runny kangaroo ass. Especially when they are designed by a Yankee and put into service in the accent kaleidoscope that is The South. The War Of Northern Aggression rages on!

We use VR software for a really basic function around here: computer password resets. All I have to do is recite a string of 5 letters & numbers and my voice is all authenticated and my access is restored. Except the only time I need a password reset is when I’ve fucked it up 3 times in a row. And the only time that happens is when I’m dilerious with fever…and then my voice is either weak or distorted by the illness. So I end up talking to a tech anyway.

7

This is the stupidest thing I’ve ever heard you say.

The fucking problem is that, even if healthcare were reasonably priced (and it’s not–what’s an aspirin cost in a hospital?) most people would still face FINANCIAL DEVASTATION if they had to come up with the moolah to pay for a simple appendectomy or broken leg. So Insurance is invoked, Insurance gets over-used by the patients and abused by the providers, Insurance responds in accordance with its basic purpose & charges premiums in proportion to the costs of care.

EVERY company in the world is in existence to make a profit, but how many Insurance employees are stereotyped as BMW/Mercedes/Ferrari drivers? Doctors? Yeah…who’s fucking whom? Stop picking the low-hanging fruit and pit some GPs who tripple bill for a single visit.

8

Amen Sista vibrotronica! Insurance companies are barren industries, creating nothing, yet sucking millions from the economy.

45 million Americans can’t be wrong!

Since you are going to pay for it anyway, why do you object to spending that money in a rational way to provide healthcare for everyone through a single payer system, which can provide it cheaper anyway? You can either pay for it in increased premiums, or pay for it in increased taxes. The uninsured are simply not going to go home and die in the dark just because you find it inconvenient to pay for their healthcare.

9

You can say it all you want, that doesn’t make it any truer than repeating “Dirty Mary” makes her appear in the mirror.

You know what? The above is true, but only on a first grade level. It completely ignores something called the “real world”, but hey, if that’s the level you want to argue on, be my guest. Here’s my reply: Nuh-uh. You’re a doody head.

Wah, wah, wah. Nobody’s twisting your arm to stay with such evil entities. I wonder, are you willing to do as I suggested earlier and put your money where your mouth is? I doubt it.

10

I’ve spent long periods of time uninsured and gone without health care as a result. I’ve seen my friends and family do the same. I had a great aunt who was uninsured die from breast cancer. She couldn’t get any insurance because she had a preexisting condition and couldn’t afford to pay for it, not because she was a deadbeat, you soulless shitheels.

I would kill for the mob before I would work for a health insurance company.

11

Gee, Dave, got something on your mind? :wink:

I’ve been fortunate enough to not have to deal with insurance companies too much in my life until last summer, when I had a motorcycle accident.

Progressive paid on time, according to my insurance policy, and continues to consult with me on my medical bills even though I’ve gone over my coverage limit (they aren’t paying, mind you, but they are making sure that I’m not paying any more than “usual and customary”).

From what I’ve heard about some companies, my experience could’ve been very bad, instead of the pleasant suprise it was.

12

:: Steps out of The Pit ::

Mr. Cancer is a bastard. My SIL is losing the same battle. Despite her (highly cooperative) health insurance she will still be dead before Christmas.

:: Slithering back into The Pit ::

Her insurance company did not give her cancer, her mother did. Her insurance company did not give her Chemo & radiation therapy, her doctors did. All her insurance company did was pay for the treatment. Because all an insurance company is is a financial institution (HMOs excluded).

If you are bitter about the whole “Pre-existing condition” phenomenon I would suggest that you are confusing Insurance with Charity. Insurance addresses the financial problems arising from unpredictable, Charity addresses the financial problems arising from known events. Once Mr. Cancer comes to call, there is no more uncertainty about the possibility of expensive treatment.

Could the companies be more empathetic when explaining this? yeah, but when it comes down to this nobody wants empathy, they want the treatment. Nobody ever stops to consider that the Banks aren’t marketing “Surgury Loans” and “Cancer Treatment Loans.” And the fact that doctors allow life-saving treatments to be prohibitively expensive (free-market and all that), and that Pharmaceutical companies are in the same bed hasn’t raised enough public outcry to effect change. Folks’d rather bitch at the entities they have funded in a FREE-MARKET not giving the farm away. Ever wonder what would happen if a bunch of uninsured people got together and set up a system in which they all contributed a chunk of money that would be used for covering medical expenses? Know what that kind of arrangement is called?

13

Well, some are worse than others. I once had an HMO insurance co. tell us that the hospitalization from the second day of my husband’s stay after an emergency cardiac bypass would not be covered because it’s only considered an emergency for 48 hours. He was still in intensive care! What was he supposed to do? I had called an asked and was told I had done everything I was supposed to do on his behalf. They argued with me down to the last dime, ending with a promise to pay the last $2000. Unfortunately, they didn’t actually write the check. I found that out 2 years later when the hospital tried to sue us for it.

Another time I had an issue when both of us had the same insurance carrier, but different accounts since each was covered through a different employer. For some reason, a doctor that we both visited sent the paperwork in to the wrong account. When I spoke to someone at the insurance co., they told me to write a letter advising the “other” carrier. “But the other carrier is YOU!” I pointed out. “You want me to write you a letter telling you something that you just told me???” "Yes. "

Someone I know who worked in a medical insurance office told me that the first and automatic response to anything large or slightly out of the ordinary was to deny every possible expense. Some folks will just give up and pay it themselves. If they appeal, it can be dragged out for a long time, and even if the company eventually has to pay, they’ve had the use of that money. There is no penalty if they make a “mistake.”

14

This happens a LOT. Even if I’ve sent the primary EOB, they still need for YOU to tell them. Guess what happens if you don’t?

YOU get a bill. Then you get mad at the facility. Trust me, we hate the insurance companies as much as you, but what choice do we have?

I’m involved in a situation right now concerning a claim for a minor. The parents are divorced, mom has taken all the medical info with her and won’t give it to the father. He’s the guarantor. That means if the insurance company doesn’t pay, he will be responsible. I don’t know anyone who can handle a $6000 hospital bill. The insurance company needs medical records from another facility. Technically, we don’t have to get involved. We could could just bill the guarantor and let them fight it out with the insurance company. I can’t do that. I’ve been working with the father to obtain the records so that I can send them to the insurance company. We’ll gladly pay a few bucks for Fedex service to not have to ultimately eat a claim of that size. We’ve even paid a patient’s COBRA payments in order to keep their policy active long enough to get the insurance comapny to pay the claim. Last year I had a $750,000 claim for a patient. We paid her $900 COBRA bill and got the claim paid. She died not long after. If we had not done that, we would have never gotten a penny.

So if you run into trouble like this, please don’t automatically blame the hospital. They want their money, too. A good facility will (should, at least) go the extra mile to help you.

15

I am sorry about your aunt. It always sucks when someone close to you dies, for whatever reason.
I notice that you said this: She couldn’t get any insurance because she had a preexisting condition and couldn’t afford to pay for it. What did you mean? She couldn’t get it because she had a pre-existing condition? Well, that’s how it works. You can’t opt out of car insurance and then realquickaddit as you are sliding on the ice towards the tree, can you? You buy insurance before something bad happens, to protect you in case it does. Or was the issue that she couldn’t afford it because they were charging her an outrageous sum of money because of her cancer? Or was she not able to afford it when she was healthy? It depends on a lot of factors, but real health insurance isn’t actually all THAT expensive. What is expensive is a health entitlement, which is what most people want. They just don’t want to pay for it.
As for HMOs, they suck because most people don’t understand what they are, and balk at being given exactly what they demanded in the only manner that is affordable.

Finally, what exactly is it that makes me a soulless shitheel? Expecting people to pay for the services they want? I’m confused.

16

Moot point now, but did she have coverage before she found out she had cancer?

17

Poor rhinocerous…

18

I think, Dave, that you’re not coming off very sympathetically as you continue to apologize – somewhat glibly, might I add – for an industry that’s pretty seriously broken and the brokenness of which severely, negatively impacts people’s lives in very serious and nasty ways.

Maybe instead of accusing people of wanting something more than what they’ve paid for (rather the point of insurance, pay them a couple of hundred dollars a month and they’ll come up with the $250,000 when you need major surgery, i.e. you’re getting something more than you’ve paid for) you can suggest ways for people to get affordable health insurance outside of the increasingly difficult route of finding a job with a company that carries great insurance. It’s very clearly no longer that simple.

And maybe you could stop saying “insurance works the way it’s meant to” because in the eyes of the consumers – who are the ones who count in this equation – it very obviously does not, and address the actual complaints that people have on their merits. Or, if you don’t have anything substantive to offer on those points, you might want to sit back and let people rant, since that was the point of this thread to begin with.