You silly person. Their job is to offer a good return for their investors. You must be some kind of socialist who thinks that people actually deserve decent healthcare. 
I used to have them also, with no problems. However last year my company switched us to a company I’ll call Sad Jesus Symbol. Now, my wife works for herself and is covered by my insurance, and for the first eight months nearly every claim was delayed thanks to a form I had to fill out to tell them that we had no additional coverage. Then “are you sure you don’t? Did anything change in the past two weeks?” It took about three calls to get them to finally stop and just pay the damn bills.
You have it. We go to a very large clinic, spread out over a few locations and covering some people with a lot of money, and we have few problems because they have a good insurance department, and good records. My insurance company just denied a claim, but I was pretty sure that the woman who drew my blood botched the coding of the procedure, and one call to accounts payable proved me right. (She botched the test also.) I don’t know how small medical offices can survive with the overhead of an insurance person handling all the crap from the various insurance companies. A single payer plan would save a bundle just here.
All of the above suggestions to start getting the lawyers involved are good, but, having been down the road before, I can tell you that what these sleazy unethical companies really don’t like is having their tawdry business practices show up in the public eye. So … what will likely really help is getting a local newspaper problem solver type person (something like *Action Line *in the San Jose Mercury News, our local paper), or TV program (*7 on Your Side *in the Bay Area), to start dealing with these dorks. Get all of your documentation, including times & dates of phone calls, in a pile, and let the world know exactly how crappy this insurance company really is. I’ll bet you get some higher-ups interested in sorting this mess out in a hurry - or else they are going to be losing business.
I am copying and pasting suggestions; thanks, and keep 'em coming.
Healthcare is a complicated business, and, if the subject has not been too done to death here on the 'dope, I’d like to start a GD thread. It’s past time to educate myself, in order to decide what I support.
Cemetery Savior, I am very happy to have your imput from your experience in the industry, along with the experiences of others in this thread of dealing with problems similar to mine. I can learn better about ideals and ideas (like possible healthcare solutions and what the government can or should do) when they are connected to people’s actual experiences. While life would be easier if everything really was black and white, that has not been my experience.
All I know from my experience is that most (if not all) of my claims have been initially denied by Untied. I don’t know what percentage, because none of the reps I’ve talked to will tell me. Part of the frustration is how little information they will give me, and how often I receive contradictory information. I don’t really know what the root cause of this is, but after a year of going in the same circles, it seems possible to me that there is some kind of corporate policy that is designed to subtly discourage some clients. It doesn’t seem likely to me that an insurance company would have a policy of denying *every *claim the first time it’s presented, because that just seems like bad business…like it would create lots more work (and therefore expense of employee resourses, etc.), and that whatever money they would save by “losing” the most expensive customers would not offset those expenses.
I guess what I’m saying is that the suggestions I’ve been given here are helpful because they’ve given me lots more options to get more information, which will probably result in some kind of resolution. It will also give me a way to learn more about the problems with healthcare (because I think everyone agrees there ARE problems) and what the best solutions might be, which will help me form an informed opinion on what to support politically.
Oh, and I loved An Archy’s suggestion on what to say. I will enjoy reading that out loud the next time I get pissed off about this, but I will read it before I get on the phone with some poor rep who gets paid $9.00 an hour and didn’t write the corporate policy and prolly gets yelled at a dozen times a day. Now, if someone could provide the phone number for the Untied CEO…
Agreed!
The one danger with switching back to Medicare is that they might have a policy stating that if the patient can get private group coverage, they must do so.
I don’t know whether this is the case - but be doubly/triply/quadruply sure before doing anything that might leave you uncovered.
If you do have the energy (and won’t risk your health in doing so), you might be a TERRIFIC person to be a thorn in the side of the insurance company. You’re home a lot due to the MS, you’re smart and articulate and you’re PISSED. Give 'em hell!!
I started a GD thread:
http://boards.straightdope.com/sdmb/showthread.php?p=11316935#post11316935
Will be back later for more…
First - to the OP I have two words for you - Insurance Commissioner. These are magic words, words that strike fear into any insurance companies heart. Particularly if your commissioner is elected rather than appointed. Send a letter to yours with information on all of the problems you have had.
Second - to those of you using this as “proof” that the US should have socialized medicine, I point out that “Untied” is practically that, given that they are going about slurping up every company they can. Government run healthcare is still not a good idea here - look at Medicare being privatized for an example. (Plus, I am still not interested in having to pay for insurance for those millions that can’t be bothered to buy it for themselves.)
All that said, since I have become unwillingly involved with “Untied” these past two years, it appears that they think they are the government and above the law. I’ve had (and worked for) private group coverage for about 25 years and in all of that time I have had to invoke the insurance commissioner once for every other company combined, and twice in two years for “Untied” and am about to do it a third time. ( I also should have sued them back in 9/07 but didn’t have the funds for a “make me feel good” lawsuit). Someone needs to kick them to the curb.
Dontcha just love Limbaugh and the Limba-bees bloviating about how government health care will “put us all in the hands of bureaucrats”?
Hey, you oxycontinized pile of whale blubber, medicine already is in the hands of bureaucrats.
What we’re arguing is mainly WHICH bureaucrats we deal with–ones associated with Sam or those associated with bosses who pay stockholder dividends, executive golden parachutes, sales commissions, and advertising out of our premiums. Lots of private health care money goes to stuff that buys no medical care at all.
I found the insurance commisioner website! http://www.floir.com/
They actually have it so I could register with the site to start my complaint, which I did. I had no idea there was such a magical person.
Funny, you’d think that the guy at Senator Martinez’s office would have known or told me about the insurance commissioner. All he said is that the Sen’s office only handles disputes with Medicare and over government entities. Then he took my name and number and said he would ask around to see if there was some other kind of group or agency who could help me. He didn’t call back though. I feel a little embarressed that I didn’t know about state insurance commissions, but less so since neither did the guy in a Senator’s office.
Proving once again that depending on the US government system tends to be a bad idea
Good luck!
Medicare being privatized is an example of a government program that is working being turned over to private industry for looting. In other words, the opposite of the point you are trying to make.
You still don’t understand that millions can NOT obtain insurance for themselves, do you?
Of course in curlcoat’s world, the poor are just lazy bums who choose not to be rich.
Just looking at the billing aspect of health care, a single payer system (as in Canada) is far superior - at least from the patient’s point of view.
I imagine that there may be situations here when a foolish government employee screws up the payment to a physician. Shit happens. But if I visit my doctor, and my doctor is not then paid by the MSP, I don’t have anything to do with it. I’m not out of pocket. I don’t have to run around and fix the problem. The doctor’s office fixes the problem, because they want to get paid; they are a professional corporation.
Plus, they only have to deal with a single insurer (the provincial government MSP), so I"m pretty confident that there are far fewer screw-ups in the first place.
The provincial government does not tell my doctor how to do her job, or how to treat me. They government does do a very good job of acting as a single insurer though.
Medicare was privatized because the government was unable to handle it. I dealt with Medicare prior to it going private, both as a second insurance payer and in trying to get bills paid for relatives, and it was a complete nightmare. This despite the fact that I had years of insurance experience.
Medicaid needs to go private as well, since it is riddled with problems.
I have never seen proof that there are millions of people in this country that couldn’t get insurance if they had made more responsible decisions. When will the time come when the responsible are not expected to continually bail out the irresponsible?
Really? I thought that I believed that the poor are just people that have less money than the middle class, and that “lazy bum” crosses all classes.
Huh. We should go to socialized medicine because it makes billing easier?
Stupid medial billing practices was the topic of the OP, so I’m trying to stay with that.
When billing is easier, administrative costs are lower, (and they ARE lower in Canada) Therefore the system wastes less money on administration, and can spend more on medical services.
Here’s 360,000 Irresponsible people who recently lost healthcare coverage.
Finally - why not just go ahead and put scare quotes around “socialized medicine”. Of course it does not scare me, but just might work for others who are scared by right wing memes.
Logically then, we should come up with a way to make billing universal and easier. Instead of just uprooting and changing everything.
I’m on dial up so I am going to make an assumption about that article - it just shows that X number of people were laid off during X time period, right? If so, that has zero to do with what I said about irresponsible people. For example, both my husband and I were out of work for most of 2008 but we still had insurance because we paid the $700 a month for COBRA. If COBRA had not been an option, we would have paid that $700 for a private policy. We had that $700 a month because we don’t live beyond our means.
I have no idea what scare quotes are, nor do I know much if anything about right wing memes. I put socialized medicine in quotes when it applies to the US because even if we do got to universal healthcare, it wouldn’t actually be socialized medicine. Tho it would be close.
I want get personal here for a moment, and sort of apologize to curlcoat and other 'dopers here who would prefer taxes not be taken to give insurance to people who have not been able to get it or keep it privately. I understand how you feel.
The truth is, I am getting more than my fair share. Making the decision many years ago to apply for disability was really tough, and I ended up doing so because I so badly needed the insurance (Medicare). My primary income comes from modest investments, so I used to work waiting tables or doing office work, primarily to be able to get insurance. But because of my illness, I couldn’t keep a job, and eventually couldn’t work at all with any reliability (in the beginning, my MS was relapsing-remitting, so I would work my ass off when I was well, and be unable to get out of bed or dress myself when I was having an exacerbation). I tried purchasing private insurance, but I was turned down again and again.
Even so, I didn’t want to go on disability at 30. I knew that there was no possible way I could’ve paid enough into Social Security to equal what I would eventually cost the government in benefits. I hated the idea of living off the taxes of others, and a part of me still hates it today. But I had to get insurance or I wasn’t going to be able to get treatment, so I took what the government offered me.
I have made many efforts to contribute in different ways, to pay forward as well as I can, and to use what the government offers as a last case. I am struggling with the stupid-head company to try to get them to pay, when I could cancel that insurance tomorrow and go back to having the government pay my claims with no trouble and far less expense. But I’m trying to do what I can, you know? And now I’m interested in seeing if I can learn about this stuff and mebbe help somebody else who is struggling with a private company.
I also pay my daughter’s private school tuition (12K a year), even though she is autistic and qualifies for tuition under the McKay scholarship here in Florida. That scholarship is designed for special needs kids to get the kind of education they need, and it’s not based on financial need. But I can afford to pay it, so I can, because I want to contribute, too. I don’t want to live off you guys.
OK, I’m a little choked up here.
Anyway, I’ve certainly made some bad decisions in my life. It’s easy to believe that everyone who needs help is only poor because they made the wrong choices, but not all of us sit around and say, gimme gimme gimme, or “how can we screw the government today?!” And certainly not all of us feel good about asking for help. I certainly don’t. Personally, I believe pretty much everyone does they best he or she can, but I can’t prove that.
So, please, curlcoat (and others on these boards, like Rand Rover or whoever else doesn’t want to pay for other people’s medical care), please accept my apologies for not making better decisions and ending up needing help. I can honestly say I did the best I could, but, in the end, I think mebbe we all do. And whatever my efforts, they haven’t been good enough to not need your help.
And to everyone, please accept my gratitude for your help (if you’re a taxpayer) and my thanks for your time in reading this.
Wow, way too much info, huh.
Don’t you dare apologize. Some people get more than their “share” from private insurance also. That’s what insurance is all about. Those of us who use less than our share are lucky, not better.
Part of living in a just society is having those who need care get it, without fear of going bankrupt or becoming homeless. We all make bad decisions, but getting sick is not one of them.
As for me, who pays plenty of taxes, I’d much rather mine went to your care than to pay the salary of some pederast Senator. I’m sure you’d feel the same way if our roles were reversed.
If people here didn’t think in black and white and enjoy jumping to conclusions, you would not have had to make this post. At least, not to me. You are not in any way the sort of person that I do not want to pay taxes toward. You didn’t have any choice in getting MS, and you are not sitting back with an entitlement attitude towards your SSDI and Medicare. My position is, and always has been, that not every one of the millions that do not have insurance are in that position thru no fault of their own - I don’t even think a majority are. Lack of insurance is only one indication of how far too many US citizens cannot be bothered to be responsible for themselves.
Hell, I’m on SSDI myself, tho I managed to make it to 51 before I had to give up working. Haven’t had to make the Medicare decision yet… 