Thank you so much for your unsolicited advertisement in yesterday’s mail. May I compliment you on the remarkable turnaround you have made, if your promotional material is to be believed, from the last fifteen years when your claims department seemed to be engaged in a creative writing contest to see who could come up with the most unusual reason for denying payment to your clients, based on my experience of the last three weeks sorting medical records.
It is not the policy of this family to pre-approve premiums on coverage such as you offer. You are welcome to institute insurance for us on these terms:
[ul][li]The first two hundred dollars ($200.00) in premium statements which you send us will be returned unpaid; this constitutes your deductible. You will extend us coverage during this period, however.[/li][li]Following this, our expert staff of bill reviewers will examine each bill you send. If we find that it is appropriate under our Family Bill Paying Policy at the time of your billing, we will pay 80% of the amount billed. You will of course have to write off the other 20%.[/li][li]Each premium statement must be accompanied by a Certificate of Actuarial Necessity produced by an independent third-party auditor that you do indeed need such a payment, and it’s not merely because you want to make money off of us. Statements not so accompanied will be returned unpaid. While we believe ourselves incapable of rising to the level of snideness your claims staff managed in the letter you sent a woman whose baby had just had his foot amputated to the effect that you had no proof that he needed a prosthetic device, we will certainly try to live up to the high standards you have set in the correspondence we send back.[/li][li]You will continue coverage during periods where we reject your premium statements, just as you continued billing people while rejecting their claims.[/li][li]There will be a lifetime limit of $5,000 in premiums; if you exceed this amount, you will continue to extend us coverage but we will not be responsible for any further premium payments.[/li][li]Since this matches closely your policy on claims, you certainly should have no objection to it as our policy on premiums.[/ul][/li]
Sincerely,
Polycarp
for the Polycarp Family Solicitation Review Board
God, I went through the same crap with the insurance I had. (It was a company whose name begins with “A.” I think you know who.)
We were supposed to have 100% coverage. They denied every single claim automatically. I started dreading going to the dentist and doctor, not because of the horrible scraper hook or shots, but because I knew what a headache it would be afterwards.
Since they ALWAYS said that I didn’t have a referral from my primary care physician, I started heading that off at the pass by getting a copy of the referral for my files. Often, I would end up faxing it to the company three times before they would acknowledge receiving it. Taking down the names of those with whom I spoke was no help, either, since for some reason, lenghty conversations never seemed to be noted in their files. “I’ll take care of that right away,” apparently is this company’s code for “Bugger off.”
As soon as we could, we dropped that company like a hot rock. Interestingly enough, the hospital where my doctor’s office is has stopped accepting this company’s insurance as well, and this is a HUGE company. I can only figure thay got sick of patients calling repeatedly for the same damn referral to be sent into the insurance company again. (Their billing department must have been a living hell.)
