Insurance companies - Why do people hate them?

In My Humble Opinion
41

When you get an auto policy, homeowners policy, boat policy, life policy, farm & ranch policy… any kind of policy… READ IT! If you don’t understand what you’re reading then call your agent and make him explain it to you until you do understand it. Don’t get the cheapest coverage on your autos either because if your bodily injury limits are only $25,000 each person and $50,000 each occurrence and your at fault in an accident that injures several people whose medical bills total more then $25,000… you’re screwed because you’re responsible to make up the difference!!

If you’re pissed that you had some jewelery and money stolen and then the insurance company only paid you what your policy limits were… don’t be pissed at the insurance company. Be pissed at yourself for not reading your policy and be pissed at your agent for not talking to you about your needs.

As for Snickers… I’m very sorry for the loss of your neice and the trauma your mother has suffered as well. I think your neice’s parents and your mother should get an attorney ASAP.

42

Hello again’s plan sounds pretty similar to the one that I was just on. You’re telling me that I have to put up with a $1000 a year increase to $4000 (not including what my employer was contributing) for “crappy insurance”?

“Work somewhere else” is not a realistic option. Are you suggesting that people strongarm their prospective employer into getting a different health insurer?

I did insurance magazines for years, and if I was operating at the loss that they are claiming to have, you can better believe I wouldn’t be driving around in the cars that they have.

The last time I needed to call them they had me in tears, and it was certainly nothing that compares to the torture that Snickers family has been through, so they aren’t getting any sympathy here, especially not since they have their own insurance against loss.

Heh, wouldn’t THAT be funny, if the insurance company had trouble collecting from their reinsurer?

43

I’m in the middle on this—literally. I work in a medical billing office, sending out patient claims to auto and health insurance companies, HMOs, Medicare, workman’s compensation claims, and everything in between. I have no particular history of bad claims against an insurance company.

One reason I think many people dislike their insurance companies is that many people misunderstand what coverage they are entitled to. Seriously. My day is taken up answering questions for people, trying to explain to them what a “deductible” is, pointing out that we, the clinic do not decide whether the insurance company will pay for something so don’t ask us, as them! and so on.

I get patients with Medicare Part A who are asking me why it doesn’t cover a Medicare Part B service such as radiology. (“Hey, did you read that booklet they gave you? No? Well, give it a whirl—it’s not Medicare’s fault.”) Or the ones who visit a chiropractor or a naturopath or an aromatherapist and can’t figure out why Medicare doesn’t pay it.

I get patients who ask why their insurance didn’t pay 100% on their MRI or their CAT scan. (“Hey, did you think to ask them? What do I know, I’m just a billing clerk.”)

I get patients whose carriers are not contracted with our clinic who get services anyway and then ask why their insurance doesn’t pay. (“Your insurance has a list of preferred providers, genius, try seeing one of those. If you knew we weren’t one of 'em, you should’ve gone somewhere else.”)

I get a great many patients who do not understand that I can’t simply bill the secondary insurance until the primary insurance has responded, or patients who think it doesn’t particularly matter which insurance comes first, or patients who figure they’ll just guess at who their insurance is and somehow it’ll all work out.

I get many patients who assume that all they have to do is turn up and announce it’s “car insurance” and somehow their responsibilities to actually file the claim have been fulfilled. Some people don’t even bother to tell us who their car insurance is or how to contact them. (“My auto insurance will pay this, just talk to Steve.” “Um, what’s their address? Their NAME?”)

I get patients who can’t figure out that when your insurance expires on December 31st, that means any services done up until then are covered; it doesn’t matter when the claim was filed, only when the service was performed.

Okay, true, there are occasionally problems caused by insurance companies themselves—for instance, an elderly MVA patient who gets a head CT done and finds out that he has a brain tumor. (MVA is Motor Vehicle Accident, doncha know.) The auto insurance hates to pay for those because obviously the tumor wasn’t caused by the accident, but the health insurance hates to touch them because regardless of what other conditions the patient has, he was treated following MVA trauma.

Other insurance-caused problems are a bit of bureaucratic bullshit with proper coding and numbers—a standard female pelvic exam, f’rinstance, is two codes (trans-abdominal and trans-vaginal) according to the CPT manual, but one particular insurance company asks its contracted providers to “bundle” the codes: that is, we only charge for one of the codes, even though both procedures were done. And they ask this even though we’re not contracted. (“We ask our contracted providers to bundle these codes.” “But we’re not contracted.” “But all of our contracted providers do it!” “We’re not one of your contracted providers!” “Well, you can’t bill the patient for it.” “Why not? You didn’t pay it.” “Our contract says you can’t balance bill them!” “Idiot, there is no contract!” and so on.)

Sometimes there are claims fouled up by patient incompetence, such as a state-provided workman’s compensation claim but the patient gives us his friggin’ Blue Cross card instead, and by the time Blue Cross gets around to denying the claim, Labor & Industries has closed his claim and discontinued payments. Or the patient who gets sent to collections after 19 months of non-payment, even though they have a welfare coupon, simply because the patient figured the insurance will pay this, I don’t have to lift a finger or tell anybody I have welfare or provide insurance coverage information or do anything, I’ll sit here and eat potato chips and throw out my bills. Or whatever it is they’re thinking.

I’m not trying to blame insurance problems on patients. Truly. It’s just that I deal mostly with patients who haven’t managed to figure out how to get the benefits of a service they are paying for. The insurance companies make me angry, too, mostly because of the sheer volume of red tape I have to hack through to get anything done. And I realize that it’s hard when your insurance rates go up following a claim, but hey, at least you’re not me—my insurance rates have been going up and I have never filed an auto insurance claim. How’s about them apples?

44

I hate my insurance company because it is a motherfucking toadraping heartless evil vile pile of rancid swampshit.

They keep changing screwing me over and changing the formulary.

I go to the pharmacy with a prescription for the same welbutrin I’ve been on for months. My HMO refuses to pay for it. Why? Because they’ve decided that they will no longer pay for welbutrin when it is used as an aid to stop smoking. Was this why my doctor prescribed it? Nope. A quick scan of my medical records will reveal that I have never smoked. I do however suffer from various mental problems which welbutrin treats. Did anybody bother to check my records or contact my psychiatrist before refusing payment? Apparently not. She actually had to write several letters explaining the situation before the HMO agreed to pay for my pills again.

A few months ago, the formulary changed to include concerta-This is just like the methylphenidate I’d been on, except that it’s time release. The level in my bloodstream stays more constant, and I only need to remember to take one pill in the morning instead of several over the course of the day. Last week, the pharmacy informed me the formulary had changed to exclude it. If I hadn’t kept an old bottle of methylphenidate, I’d currently have no attention span, and have panic attacks about once an hour.

When I called my psychiatrist’s office to report the problem, the receptionist asked what insurance I had. I told her and apparently a lot of patients with the same insurance have been having similar problems.

That is why I hate insurance companies. Please note, that out of nigh 3000 posts I’ve cursed in perhaps 10. That is how much I hate my HMO.

45

The movie, *As Good As It Gets *has a prety good definition of HMO…it eludes me at the moment though. :rolleyes:

never mind.

46
  1. It was Mark Twain.
  2. It was about bankers.

Full quote:
“A banker is a fellow who lends you his umbrella when the sun is shining, but wants it back the minute it begins to rain.”

Note that a lot of insurance company problems were caused by bad investments in the 1990s. This is not mentioned when they go shopping for congress critters for urgent needs like tort “reform”. Blaming others for your own problems is not a sign of a well-adjusted business sector.

47

I am a litigation lawyer in Ontario. I, and the other litigators in my firm, have noticed that insurance companies have been buying each other up, resulting in fewer insurance companies, and that most insurance companies are tightening up on claims payments. This has resulted in a bit of a boom for us in going after insurance companies that have improperly denied claims.

Quite simply, most insurance companies are cutting coverage as contracts come up for renewal. While legal, this sort of behavior does not pass the sniff test for folk who thought that the insurance contract they signed bore some resemblance to what had been advertised. It takes specialized knowledge to read and understand most insurance contracts, so customers simply have to trust in their insurance companies. When the insurance companies betray this trust, albeit legally, by ceasing to cover items that they used to cover, it pisses off their customers who only find out about the decreased coverage once they make claims.

That is not the end of it, though. Some companies are out and out denying small claims for no good reason. Most people will not sue an insurance company for a few dollars, so by denying a great many small claims, an insurance company makes a lot of money, even if a few customers take them to court occasionally.

Some companies are denying major claims for no good reason. The numbers on this sort of denial of benefits are brutally simple: on any given major action, wear down the claimant until in the hopes that the claimant will settle for significantly less than the full claim, and more importantly, establish an overall litigation chill that will dissuade people from taking on insurance companies.

Some of the denials of benefits are truly egregious. Not all insurance companies behave this way, but many do. It is getting more and more difficult to find a company that does not behave in this way.

My own firm is changing its insurance company, not due to cost, but due to our concern that it will deny a major claim should we ever make one. Quite simply, we have seen which companies deny claims for no good reason, and our existing insurer is one of them, so we are taking our business elsewhere. Due to the insurance industry’s consolidation, there are surprisingly few insurance companies out there for us to chose from, and unfortunately we do not feel comfortable in taking our business to most of them.

48

That’s another thing that pisses me off-what does one do when one has a “pre-existing condition”? For me it’s my anxiety disorders.

What’s up with that? I mean, those that need insurance the most are denied because they need it?

49

[QUOTE]

Snickers, I am so sorry to hear that this has happened to you family. And please don’t take my previous posting wrong; I was just attempting to make a humorous spin on a very touchy subject. Please note that I am not taking the side of the insurance company, I have seen what can happen to people (therefore I sometimes absolutely hate my job with a passion).

My best advice to you is that your family needs to get a lawyer involved. I have never seen a auto claim where a death and/or significant injury does not involve lawyers for just about every person involved. Many times even when liability for an accident is disputed insurance companies would prefer to just pay out.

Inigo Montoya has given you some great advice, follow it. And get a lawyer.

I am hoping the best for your family…

50

Move to Maryland. They instituted a guaranteed issue insurance that’s available to any state resident who is turned down for insurance by a private carrier, underwritten by the state. It’s quite reasonable, too. Sadly, Pa lacks such a plan.

Also, depending on the nature of the siezure disorder, my company will insure the client. Petie Mal w/i 2 years would get a temporary waver on the condition, no siezures for over 2 years, standard coverage. Grand Mal is no coverage for 5 years and then coverage with a permanent waver after that.

A lot of people just don’t understand their coverage. Fortunately, my company is pretty good about paying claims, and I take my job as an agent seriously, I will work with a client to make sure his EOB (explaination of benefits) form is accurate and understood, but I remember one guy, he had an operation, called me up, I went over to look at the EOB. It looked right to me, I showed him that we had paid 80% of the claim;
“You do remember that I told you this was an 80/20 plan, right?”

“Yes, I remember”

“Well, see here, we paid 80% of the bill. What is it that you think is wrong here?”

“I pay for insurance. I don’t want to pay anything.” :smack:

He also didn’t want to pay the $100 more a month in premiums the 100% plan would have cost him, I remember. :rolleyes:

He may very well tell people a story like some of the ones in this thread, about the damn insurance company that screwed him, but I ask you, who is at fault here? The insurance company that paid the claim as outlined in the policy, or the client who A: Didn’t understand his policy or B: Wanted coverage that he wasn’t willing to pay for?

I see this a lot. A LOT. People say they can afford to pay $X, and when you put together a plan that gives them the maximum amount of coverage they can get for $X, the demand the coverage that costs $Y, for the X price! Then they are unhappy that they can’t get it! Go into a car dealer and tell them that you want to buy that new Caddy, but you’re only going to pay $10K for it. Everyone would agree that this is crazy, what’s the difference with insurance?

51

I’ve probably had more issues with doctors than with insurance plans per se, but those of you with ongoing medical issues may want to thnk about how you can leverage matters with your insurance company.

A few years ago, I had a bad leg injury and a lot of surgery and rehab. The ankle was still giving me a lot of pain, and my doc was not crazy about the idea of more surgery, because the more often you open up the joint capsule, the more permanent damage you wll have. He wanted to try something which was not FDA-approved for ankles (although it is for knees): basically, synthetic cartilage. The insurance company didn’t want to preapprove it, but when I pointed out that they would definitely have covered surgery and rehab, which would have been far more expensive than the few hundred dollars to try the synthetic cartilage, they decided to approve it.

Just try to figure out how to make it be in their best interest.

52

I’ve had very limited experience with insurance claims (which is probably why I’m so happy with USAA!). I did have a weird experience with a health insurance claim. I was approved for some pretty intensive jaw surgery. I had the jaw surgery and then received two bizarre calls from the insurance company:

  1. “We see you had jaw xrays, I’m sorry, we don’t cover jaw xrays.” Okay, you approved the surgery for this guy to cut into my face, but you won’t let him have a quick sneak peek of the area before he starts cutting? Claim was approved and they paid.

  2. “We aren’t going to pay for the anaesthesia.” Okay, you approved the surgery for this guy to cut into my face, but you expected me to be awake while he did it? Claim was approved and they paid.

I just found both phone calls to be extremely weird.

55

So says a shill for an insurance company.

56

Oh… Dear… Og!

ZOMBIE NED RYERSON!!!
AAAAAAARRRRRGGGGHHHHHHHHH!!!

57

Ned?
Ned Ryerson?
Needle Nose Ned?

58

zombie or no

you aren’t always in good hands.

59

Insurance companies are to their customers like the Spanish conquistadors were to their subjects. Or the English to the native Americans. They want the premiums and then they will use every excuse to squirm out of paying, whether the excuse is legitimate or a load of malarkey. If you’ve got an insurance company that pays claims, don’t switch to save a few bucks. Especially to a company that advertises a lot.

60

If he’s a zombie… and he does that cat-purr-gurgling sound… will his jaw fall off?

…cause I am NOT cleaning that up…!

Oh… and as to the OP… something about “Protection Rackets” are extortion, but insurance companies are totally legit was always hard to swallow.

61

It’s interesting the posts about pre-existing conditions disqualifying them. Obamacare makes it so you can no longer be denied for them (us healthier people just subsidize your care, which I’m generally OK with).

Medical insurance is so different than most insurances that it’s really silly to even call it the same thing. If car insurance was like medical insurance, you’d expect for them to pay to fill up the tank and change the oil. For most people, medical insurance is just a medical prepayment plan, maybe with some tax advantages.

The one time I’ve had to use my auto insurance, it was great. I had a pretty high deductible, but they paid the excess to fix my car to how it was before the collision. The bigger part of course was the personal injury claim from the guy in the other car. They hire a lawyer and deal with all of that, which would have been hell if I’d been on my own. I don’t even know what the eventual settlement was, because it doesn’t really matter to me. That claim alone is probably worth many years of insurance premiums, just for the hassle, let alone however much each insurance company paid for the injury. Yeah, my insurance went up a bit for a while. Big whoop. I will never complain about paying for insurance again, it would have been so bad if I didn’t have insurance then.

62

Yup. Question answered in the first reply.

If they don’t raise rates or cancel your coverage, they try like hell to weasel out of paying anything. The knowledge they are using your money you paid them for years to hire people to avoid their responsibilities is offensive.