Insurance company poopyheads

The BBQ Pit
1

I don’t usually pit. I don’t usually even post. But I’m going crazy with this and want to vent in a forum where intelligent people can talk me down if I am overreacting, or at least make fun of me in a manner that will amuse me.

I have private insurance now. I am disabled and have had Medicare for 12 years. Last year, **parthenokenesis **got a job with insurance benefits. Since his business (which, for clarity and anonymity, we will call “partheno-biz”) has more than 25 employees, this makes the private insurance company (which we will call “Untied”) my primary insurer. I was delighted with that, since anything we can do to save taxpayers money, yay that, right? Only trouble is…”Untied” is, at best, composed of incompetent dingledorks, and at worst, compiled of unethical poopyheads.

They start by automatically rejecting every claim. After the different providers try to work things out with “Untied”, they usually call me and ask me to follow up. So I do, by calling “Untied” and telling them the same information every time. The “Untied” rep will ask me if I still have Medicare (yes), did the Medicare coverage begin in 2008 (no, it was 1997), and then he/she will tell me that their records show that Medicare is supposed to be my primary. And I tell him/her (just gonna go with him now) that Medicare always tells me that “Untied” is primary, because “partheno-biz” has more than 25 employees. And then the “Untied” rep will tell me, “we are only primary if his business has 140 employees or more”, which is apparently untrue, but also irrelevant, because “partheno-biz” does have more than 140 employees anyway. After we finish this part of the discussion, we usually move on to unpaid claims, and this involves lots of hold time while the rep looks things up, and more conversation time while the rep tells me first one thing (like, “all seven of these unpaid claims are from the same provider”), then another, (like, “oh, all seven of these unpaid claims are from *different *providers”), followed by a different wrong fact (like, “the therapist who came to your house twice billed us $13,000”), then a correction (like, “oh, that $13,000 was for your brain surgery”), followed by a stupid question (like, “did the provider who billed $13,000 for your brain surgery perform the service in your home?”). After this portion of the entertainment, the rep will usually tell me that he needs to transfer me to a “specialist” to help me with my problem. Sigh. (I sigh, see, because I know what’s coming.) So I get transferred, and invariably, I have the SAME FREAKIN’ CONVERSATION with a new person, complete with many of the same falsehoods (like, “Medicare is supposed to be your primary”) and many new ones (like, “our records show that you have never called us before”). Then we continue through this verbal dance, the new rep tells me he has corrected all the problems, and that all claims should be paid in a week to ten days, and la dee freakin’ da, isn’t life grand? And we hang up, and then guess what happens?!!1!

Apparently, not much.

The next month, I get the SAME FREAKIN’ PHONECALLS from the providers (unless they’ve given up, in which case, instead of phone calls, I get notices from collection agencies trying to collect medical bills that have never been paid by insurance). “Untied” has apparently paid a few bills over the past year, but, with most of these claims, I’ve had to go through this same dance at least a couple of times to get even a partial payment from “Untied” to any given provider. Some are still unpaid, though, and the smaller the office, the less likely they are to get paid. One of the hospitals I’ve been in got very aggressive and got paid without me having to call “Untied”, but that’s the exception.

There is so much more to this foolishness, but oh, look! Took a break to greet parthenokenesis, who is home from work. He brought the mail in, and SURPRISE! Another new medical bill with a notation that insurance denied claim. Reason given…? “Need more information about patient’s insurance coverage.”

WHAM WHAM WHAM

Pretty sure y’all can guess what that sound was.

2

Similar to fap fap fap ?

3

Sorry to hear about your frustrating billing troubles. I once had insurance with Untied, and they paid everything on time with never a problem. It was very, very, expensive, too.

Maybe you got the problems I should have had. Sorry!!

4

Yeah, they are, and are pretty well-known for being so.

I don’t have anything to offer but my sympathy, and that you have.

5

So… do you wish you could go back to Medicare? But wait! Private insurance is supposed to be so much better than that evil gub’ment insurance!

Look, the insurance company is not your friend. Please tell me you are documenting all these phone calls? Who you talked to, date, time, time on hold, number of transfers…? You will need it for the official complaint you will eventually file that might or might not give you satisfaction.

This is how insurance companies make money - by finding any and all reason to delay or deny payment of claims. Makes you want to puke, doesn’t it?

6

Sounds like it’s time to get someone with the letters JD after their name to write a nasty letter with little phrases like ‘triple dammages’ in it.
Amazeing how that works sometimes…

7

Insurance companies are in the denial of service business. Another poster mentioned she called and called until she got the company to cover her. They told her that most people don’t have the fortitude to continue fighting and bitching. They just give up and the company makes more money. That is not a company trying to cover its customers. That is our system.

8

Insurance companies are out to make profit. They can make profit most easily by denying claims.

I’ve had some nasty experiences in the last few years, too, and I’ve become a firm supporter of socialized medical care. The government can’t possibly screw it up worse that the insurance companies have.

9

All I can think is “Jack Daniels”, and I broke up with him in '04.

Yes, this, and also what gonzo said. I am pretty naive, but after dealing with this for a year, I became convinced that they were turning down claims and making me jump through hoops (try that in a powerchair!) in hopes that I would simply give up and pay the claims myself. With a couple of my favorite doctors, I have actually done that, and they’ve told me if they ever get any money from Untied, they will send me a check.

That was about the worst thing I could imagine until today, when parthenokenesis said that they are trying to make me quit being their customer. And I said, but that’s silly! What kind of business model would make sense where a company would try to drive away all their customers, and he answered, “Not all their customers, sweetie. Just ones like you.”

It was a bolt of lightning. I’m an expensive customer. If they ran off all the ones like me, they could pay out fewer claims and make more money! Duh.

I don’t know what the right choices would be for health insurance for our country. I’ve stuck with Untied because I would like to not make all y’all taxpayers responsible for my healthcare expenses, you know? But I also don’t really believe the idea that “the gobernant screws up everything it runs” because I had zero problems with getting medical bills paid by Medicare, I didn’t have to jump through hoops, and I got quick responses and good help on the rare occasion that I needed to call Medicare (you know, when I started having problems with Untied). Also, it seems to me that, since Medicare is not trying to make a, you know, profit, that it ends up being cheaper. And there’s no motivation for some Medicare executive to introduce new ways to make money at the next board meeting, like, “Hey, if we make the disabled people fill out extra forms, maybe they’ll get confused, and they’ll pay the bills themselves!”

That’s the sound I think I heard on the other end of the line. Tee hee.

Also, the sympathy expressed and all the responses are much appreciated.

10

That’s a suggestion to “lawyer up.” Sorry to hear of your troubles.

11

I hope you’re documenting all of your conversations with them. Preferably in writing.

Otherwise, I have a nagging habit of responding to those automated warnings that this call may be recorded for “quality assurance” purposes that this phone call will be monitored for legal purposes.

12

Obviously that’s where they get all their brain surgery done.

13

Stop saying that! Better yet, stop believing that! Please! You, like millions of others, have been brainwashed to think that somehow using Medicare/tax money is a bad thing. It’s not. Tell me, before you were disabled did you pay taxes? Do you pay taxes now? You know, part of the reason for paying taxes is to support programs for the greater good, including Medicare. In that sense it is your money and you are entitled to it. In any other civilized country there would be no question that you should get hassle-free medical care, it is appalling and shameful how America handles health care.

No matter what, your premiums do not cover your medical costs. Doesn’t matter what sort of insurance, that’s a fact. Either your fellow taxpayers subsidize your care, or the other customers of Untied subsidize your care. And guess what? The customers of Untied are also taxpayers. It’s just that the burden per individual is actually less for Medicare because the burden is spread over greater numbers.

Going with Untied does not, in the end, save money. In fact, it will inevitably cost more because they have to show a profit. (And then pay taxes, some of which goes into Medicare).

Now, I am not a lawyer, doctor, or any professional of that sort, but if I were you I’d hire a lawyer and try to find a way to get back on Medicare. The lawyer may only have to write a few nasty letters letters, because health insurance companies view being hauled into court as expensive. Make it cheaper for them to pay the frickin’ claims than to ignore you - threaten to get even more expensive via legal means.

And stop it with the “save taxpayers money” schtick. That’s not YOUR responsibility, m’kay?

14

Broomstick, you have hit at the real heart of the problem for me. The idea of trying to be responsible as a citizen by keeping this private health insurance is wearing thin, precisely because it seems less and less that it actually helps other people. Of course private insurance is going to cost more, since a private company is supposed to show a profit. And while I would love to believe that no executive at any company tries to make money through any unethical means, that is simply not human nature. A great deal of the frustration in dealing with Untied is that I am free to cancel my insurance with them and go back to using Medicare. The only thing that has kept me with this company is trying to do whatever tiny thing I can do to reduce the deficit, ha ha. I know it’s stupid to think it makes any kind of difference, but I am very much a believer in the importance of being the change I wish to see in the world.

The truth is, it’s not helping any taxpayers to keep this insurance. It’s costing money out of my husband’s paycheck to pay premiums, and I’m paying more in medical bills than I’ve had to pay in years. Several people have mentioned consulting a lawyer, and I want to do that, but again, because I think it might benefit other people. In other words, if I engaged in a legal fight, it might have the effect of forcing at least one company to stop pulling this crap. But, having had experience with a couple of lawsuits in my lifetime, I have found them to be extremely draining of money, resources, and time, and (even though I was the “winner” in both cases), the small amount of money I was awarded was far less than the original loss and the expense of the lawsuits.

Having said that, I am going to spend a few bucks talking to my attorney about the situation and see what he says. But, unless someone here can give me a good reason not to (and I am open to that, since I come here to fight my own ignorance, not anyone else’s), I am going to cancel my insurance with Untied. Sad, ‘cause that means they will win.

15

Then I suppose you need to define the change you want to see in the world. Do you want to see honesty in business? Then fight for it. Do you want people to have affordable healthcare? Then fight for it. I would much rather know that I’m spending a little more money than I do now if that means that you, and people like you, and friends of people like you know that you’re not getting shat upon while dealing with serious health problems. Returning to a sense of normalcy after serious health problems is difficult in the best of circumstances. Fretting over your insurance provider being a douchebag surely doesn’t help.

Getting a person like you back into as good of health as possible so that you can continue being a productive member of society does help us. There are plenty of people who have no desire to be such a person; we need your kind to offset their kind.

Yeah. That’s the shitty part right there. But if your actions can reduce the hell of the process for the next person, and you’re up for the fight . . .

Well, for the moment, I’d say worry about you and let us worry about us. If that means us picking up the bill for a while, I’m happy to contribute through paying my taxes.

Of course, there could be a certain pleasure of keeping the insurance and maintaining exquisite records of all communication with them (record conversations, require everything in writing, or better yet - have a lawyer do it) to return the favor of making one’s life a hell . . .

16

Now THAT sounds attractive. Sticking with them a bit longer in an effort to have some small impact for others will give me a better way to contribute.

I do have to weigh things more carefully these days in terms of what any given effort costs me; I have progressive MS, and pushing myself too hard throws me into a relapse, which increases my dependence on others, and makes them have to work harder. I used to contribute through volunteer work with special needs kids. Can’t do that anymore, so I am always looking for something constructive I can do, and wrasslin’ with Untied might be just the ticket.

Thanks, all, for the encouragement and suggestions (like making detailed notes about calls). I’m gonna fight ‘em, and see what happens.

17

Have these morons paid a single dime yet?

I’m convinced that insurance companies do their best to deny claims if they can find the least ground to do so. Years back, we used to have dual coverage because at one point, if company A (primary) paid 80%, company B (secondary) would pay the remaining 20% (and in our case, coverage B cost us nothing). At one point, A and B were different offices of the same company, Denyl-care. This led to much hilarity, including cases in which office B would forward the claim to office A for payment, utterly ignoring the attached EOB which accompanied the claim.

We finally got rid of the “free” (to us) secondary coverage because of this, and because company B changed over to a model that said “A paid 80%, we’d pay 80% also but A already paid that, so you get nary a dime from us”.

And my dental insurance… with GetaLife… has a policy of denying anything but the most basic claims (seriously - every crown I’ve had done has initially been denied), and they don’t cover any anesthesia other than novocaine. As a person who a) has trouble getting adequately numbed with novocaine, and b) has SEVERE anxiety as a result of that, I need nitrous oxide. We fortunately can pony up the money for the nitrous but a lot of people could not.

I would suggest contacting your state’s insurance commissioner and reporting this bullshit. Also make sure your husband’s company’s HR department knows of it.

Lawyering up is not a bad idea either though costly.

Definitely contact your congressperson / senators.

Look into organizations that are pushing for healthcare reform and tell them your tale.

Look into the legalities of recording phone calls. I seem to recall it’s not legal unless you tell the other party (i.e. you can’t record them; they already have that “for quality control purposes” disclaimer on their end). Be prepared for them to refuse to talk to you at all when you make this disclosure (bastards!!!).

Write up a letter describing the legalities, including citing the applicable statute (25+ employees, you’re primary!) etc. Have that attached to EVERY CLAIM - as in, provide your doctors’ billing people with a stack of copies of the letter to attach to the claim when they send it in. This is assuming they file via mailed paper claim vs. electronically of course (I wonder - if electronic, do they have the ability to attach scanned documents? You’d think they would need to!).

18

Mama Zappa, yeah, they’ve (eventually) paid a few claims, mostly to the hospitals. I think this is because the hospital billing people are more aggressive and experienced in getting claims handled.

Your experience with insurance sounds even more absurd than mine.

These are some great places for me to start. I called Senator Martinez’s office yesterday, because I get his newsletters, and there are always stories about his office helping people with medical claims. However, the person I spoke to said they only help resolve problems with government agencies, so no help there. But I will find out what kind of state insurance commissioner there is and what they can do, and I will ask parthenokenesis to follow up with his HR person.

thanks, all y’all

19

Very much something that varies by state. Some you don’t have to give permission since one party (you) knows that the conversation is recorded. In others, both have to know.

So yes, looking into the legalities would be good.

20

That’s why I offered up that she can, in response the the pat “this call may be recorded for quality assurance reasons”, “this call will be recorded for legal purposes.” That puts the other participant on notice that the call is indeed being recorded. The company may decline to be recorded, which reduces the conversations to print - preferable in my mind anyway.