It took my major insurance company six weeks, multiple phone calls from my neurologist, multiple phone calls from me, multiple faxes from me and the neurologist (they kept getting “lost” or “not received”), being caught in half a dozen “inaccurate statements”, intervention from the medical director to whom I report at work, AND our rep at the office stepping in to get Botox for migraine paid for. I’ve had the treatment for the past four years and it’s totally changed my life.
But the insurance company at the new job kept saying I didn’t meet their guidelines, even when I clearly did. It’s a standard medical policy.
They lie, they cheat, they lie some more – to save a few bucks on a self-insured employer plan, which means the EMPLOYER is paying for the treatment. Not the insurance company.
ETA: I cannot imagine having this kind of trouble for an actual life-threatening condition.
That’s why people hate health insurance companies.
I believe in France once a doctor submits a bill the insurance company is forced to pay it in 10 days or face a fine. That would be a nice system. No weaseling out and harsh punishments for trying to do so. Plus it would save a lot of doctor overhead by them not fighting these companies.
Botox isn’t even that expensive, I thought it was a few hundred dollars per shot. I’m sure they weasel far worse for more expensive therapies.
Sorry, but that analogy just doesn’t work. Protection = “you must pay or else something bad WILL happen”; insurance = “you can choose to pay and be covered IF something bad happens”. Way different concepts.
I’m more than pleased with my car insurance. It’s probably more due to the agent than the company, but I always get a quick response and great service when I need it. I could probably get coverage cheaper, but sometimes you get what you pay for.
As for health insurance, I’ve had good and bad experiences. I had to bump heads with one (employer provided) health insurance comapny more than once to get a claim paid, even escalating an issue as high as the State Insurance Commissioner once, but it was eventually resolved in my favor.
TLDR - I don’t hate insurance companies, but there are some that I’d rather not ever do business with again.
The policy of the gold level plan said fillings were covered, but they refused to pay for the glue used to attach the filling. The claims dept drones refused to budge, so I called one of their lawyers and said that I would be suing for the claim plus full recovery of my legal costs. He saw to it that the claim was paid forthwith.
The policy of the gold level plan said endodontics (root canals) were covered, but they refused to pay when the work was done by an endodontist (a dentist who specialized in endodontics) who charged the same as a regular dentist. The claims dept drones refused to budge, so I called one of their lawyers and said that I would be suing for the claim plus full recovery of my legal costs. He saw to it that the claim was paid forthwith.
One of the lawyers in town had a massive stroke. He lived, but only as a non-coherent person with a body that had to be constantly attended to. His insurance company denied his extended medical benefits and income replacement/disability claims on the grounds that he was fit for work. Several of his friends before the bar successfully represented him for free out of disgust over how the insurance company had tried to screw him over.
A friend in one of our southern colonies quit her job with an insurance company because she felt dirty. Her job had been to deny medical claims. Not review them – just deny them without review. The insurance company saved enough on the denied claims that were not appealed, and earned enough interest on the delay of claims that were successfully appealed, that they made a profit on her and others holding the same job.
So yes, the claims side of the insurance industry that deals with health and disability coverage is evil. In my books, routinely acting in bad faith despite insurance contracts being of the utmost good faith is evil.
Simplest solution? Escalate at the first hint of shenanigans, and if the insurance company does not pony up forthwith, send a demand letter with a deadline, and commence a claim if the deadline is not met.
I’m not a fan of insurance companies, not because they do their damnedest to pay out as little as they can, and to charge as much as they can. That makes sense from a business perspective, as infuriating as it can be.
I don’t like them because of the hypocritical bullshit and lying that their marketing/sales departments do.
For example, I work for a health insurance company at a remove (they own my non-insurance company). So they change up our health insurance for the worse- we went from a regular PPO plan with co-pays to some sort of high-deductible plan with a HSA. They then gave us this totally fraudulent dog and pony show about how if us subscribers are more personally on the hook for our health care costs, we’ll make better choices and everyone will be better off. First of all, few people here work here long enough for their health care choices to come back to bite them (or our parent company) in the ass. Most people are in their 20s, 30s and 40s, and probably work here an average of 5-10 years, not 25 and retiring. Second, a LOT of us have children (or childbirth) as our highest consumers of health insurance. Third, stuff like the flu, allergies and random accidents aren’t things you can prevent through smart choices.
So for me, it just seemed like a bullshit set of excuses for them to camouflage their revamping of plans with the advent of Obamacare and/or stick the subscribers for more of the cost, while not charging lower premiums.
Same thing with all the other insurance companies that talk about how they care about you, etc… they don’t. You’re just a number to them, and they’re most interested in making money, not helping people out when they’re in need.
I’d have a lot more respect if they just owned up to what they’re doing.
