...Same logic is applied to the case above with the insurance policy. You better know your policy when you sign up, or the gist of it, or at least know where to get more info, and etc. Being totally ignorant of it and then blaming it on the insurance company for taking advantage of your ingorance sounds a bit ridiculous. The insurance company was morally wrong to do it, but the blame also goes to the other side as well.
I won't even talk about the rape stuff. You have no idea how you sound in that part of your post.
The thing that you miss is that the insurance companies (I have worked in this industry for 15 years as a manager and director) purposely deny claims and procedures that they know are covered. You do not blame the victim. Well, I guess that you do, but that is disgusting beyond belief...
I won't even talk about the rape stuff. You have no idea how you sound in that part of your post.
The thing that you miss is that the insurance companies (I have worked in this industry for 15 years as a manager and director) purposely deny claims and procedures that they know are covered. You do not blame the victim. Well, I guess that you do, but that is disgusting beyond belief...
Yes, I believe there are insurers out there who probably do what you've described: "Deny claims they know are covered just hoping the consumer will not take issue with the denial". I believe news organizations have broken stories on the topic in the past. I do believe, though, that there are many (probably the vast majority) who do not seek to deny claims they know are covered. Taking my company as an example, I am very comfortable with the integrity of our claims process -- we always look for ways to pay a claim, not deny it. All insurers, though, must deny claims they are not required to pay; else, they will not be able to pay the claims they need to pay for all their other clients. The "many" in this case are more important than the "one" so to speak (thanks Spock). Posted via Mobile Device
Re: After all the fuss, public health plan covers few
Quote:
Tide1986
...The "many" in this case are more important than the "one" so to speak (thanks Spock).
Over the last 15 years, my family has been covered by no less than 8 different healthcare insurance companies. All of them have done this to us. ALL OF THEM! We have won every appeal, and we appeal every denial. Hmmm, see a trend?
If you think that this is limited to only a few bad eggs, you are misinformed. It is a standard practice across the industry.
Re: After all the fuss, public health plan covers few
Quote:
NYBamaFan
Over the last 15 years, my family has been covered by no less than 8 different healthcare insurance companies. All of them have done this to us. ALL OF THEM! We have won every appeal, and we appeal every denial. Hmmm, see a trend?
If you think that this is limited to only a few bad eggs, you are misinformed. It is a standard practice across the industry.
Then all we need is a bill that will allow family members to sue for punitive damages for any patient that was denied treatment that resulted in death or life altering results. Insurance companies would think twice about denying the truly needed treatments. This could be done on a 10 page bill that would regulate and not dictate.
Re: After all the fuss, public health plan covers few
Quote:
Ark-Tider
Then all we need is a bill that will allow family members to sue for punitive damages for any patient that was denied treatment that resulted in death or life altering results. Insurance companies would think twice about denying the truly needed treatments. This could be done on a 10 page bill that would regulate and not dictate.
That would be a great step in the right direction. Of course, the damages would have to be set high enough to move an industry that is willing and able to spend over $1MM per day on lobbyists...
Re: After all the fuss, public health plan covers few
Quote:
NYBamaFan
Over the last 15 years, my family has been covered by no less than 8 different healthcare insurance companies. All of them have done this to us. ALL OF THEM! We have won every appeal, and we appeal every denial. Hmmm, see a trend?
If you think that this is limited to only a few bad eggs, you are misinformed. It is a standard practice across the industry.
BC/BS has denied legit claims for me on occasion. Each time, I get the doctor/service provider to resubmit with additional paperwork explaining why the services were necessary. So far, so good.
In one case, I wasn't too surprised, as it was a wonky eye condition. But when they denied a cardio workup even though I was having some chest pains, have a family history of heart problems, and am already 4 years past the age when my dad had his first heart attack...that's pushing it a bit.
__________________ "But I don't want to go among mad people," Alice remarked.
"Oh, you can't help that," said the Cat: "we're all mad here. I'm mad. You're mad."
"How do you know I'm mad?" said Alice.
"You must be," said the Cat, "or you wouldn't have come here."
Re: After all the fuss, public health plan covers few
Quote:
NYBamaFan
Over the last 15 years, my family has been covered by no less than 8 different healthcare insurance companies. All of them have done this to us. ALL OF THEM! We have won every appeal, and we appeal every denial. Hmmm, see a trend?
If you think that this is limited to only a few bad eggs, you are misinformed. It is a standard practice across the industry.
Your in a business you don't agree with? I see a problem. I too, like others here, have had BCBS of Ala and am now with Anthem BCBS and have never had any issues with medical claims with either. Have you tried BCBS insurance? I also read what is and what isn't covered and if I don't know or don't understand I call the company and talk to a rep.
On the business of a gov't run health care: The gov't has no business running ANYTHING. They are there to set regulations and rules. And yes, a lot of the regs and rules are crap. They are here to make sure the public are treated properly. If they were a private business, they'd have gone bankrupt and failed decades ago. I agree with a few things on the bill but a public option has no buisness being there. If you look at the stats (I use to know the site) the U.S. has more deaths, total, but if you look at percentages, we are one of the best. Idea #1, no SSN or legal right being here: no service. Now the cost of care has gone down, the insurance prices can go down and the gov't doesn't have to subsidize (sp) hostipals.
Look at Mass and Tenn. Tenn had to do almost a complete overhaul on TennCare and Mass is broke because of their socialize medicine. I like what I have and see no reason for the most part to change it.
Re: After all the fuss, public health plan covers few
Quote:
Bamaman-n-KS
Your in a business you don't agree with? I see a problem.
I am an IT Director for an insurance brokerage company, not an insurance carrier. We have to help our clients fight through this stuff every day.
Quote:
I too, like others here, have had BCBS of Ala and am now with Anthem BCBS and have never had any issues with medical claims with either. Have you tried BCBS insurance?
I have had BC/BS of IL for the last 4 years. Same story, different company. BC/BS is different from state to state. BC/BS in AL has a great reputation.
Re: After all the fuss, public health plan covers few
Quote:
NYBamaFan
Insurance companies have panels of doctors who decide which procedures will be approved, and which will not. So, let's say that you get sick and your doctor thinks that you need an MRI to check out something strange somewhere on your body. The doctor fills out a form to get the procedure approved before booking the MRI (or you fill it out with your doctor - depends on the insurance). Now come the part that kills people every day.
That panel has a simple job. Review the procedure requested, check your policy to see if it is covered, then approve or deny based on your policy. Not based on medical need - the doctor determined that. The panel can over-rule the medical need, too - but that is a rare occurrence today after the HMO doctors went to jail.
Now, these people on the panel, with their simple jobs - they face a conflict of interest. They are paid, promoted and bonused based on the % of their claims that are allowed through. Yep, they have to deny claims and procedure requests to get promoted, receive raises, or get their bonuses.
How can they get away with that, you might ask? Well, because there is an appeal process, it is not illegal to deny a claim - even if you know that it should be covered. Same goes for a procedure request.
The problem - only a tiny percentage of policy holders know this. Very, very few appeal. This is what the insurance companies are counting on.
So, you are this person whose doctor recommended the MRI. The panel denies it. You don't know your rights, so you don't appeal. It is cancer, and it kills you when you might have been saved with earlier detection from this MRI. Or maybe you know your rights and appeal, but the delay because of the appeal costs you your life.
This is built into the insurance company model. It is business as usual. It happens every day in America. It is tragic, and it should be criminal - but it isn't. This has happened to friends and family, including my wife's 34 year old cousin.
And this does not include the number of deaths from uninsured/untreated illnesses...
And a government backed plan does the same with even more denials even when that patient is on the opperating table with their chest cavity opened. It has happened to my grandfather. The surgery had been started as it was an emergency open heart surgery. During the surgery, the board decided that it should not have been started which led to an appeal. While the decision was being waited on my grandfather lay with his chest cavity open for over 24 hours. He got an infection, which was exactly what my Mother was telling them was going to happen if they did not close him up. She is retired from the medical field and is very knowledgeable about the procedures. by the time they decided they could move forward with the surgery it was too late as the infection was already set in. He died because of government beauracrats. My grandmother, in July, had two lumps grow on her inner thigh. The fear of what we knew came true. She has cancer. We just had this conformed two weeks ago because they could not schedule her for an appointment until then because of the medical system that again is run by the government.
Somehow, people think trading one bad system for a worse system is the answer. I do not.
Re: After all the fuss, public health plan covers few
Quote:
NYBamaFan
I have had BC/BS of IL for the last 4 years. Same story, different company. BC/BS is different from state to state. BC/BS in AL has a great reputation.
I was swapped over from BC/BS AL to BC/BS of Illinois abouth 3 years ago and have seen no change. My wife still uses BC/BS of AL and we see no difference.
What I determined early on is that if you have a doctor who has a problem processing claims, switch doctors. We have pretty much settled in on doctors that meet the needs of our family and have people working for them that know how to file the claims that do not get rejected. For example, I had a doctor work on my left knee and we had problems with BC/BS of AL covering the entire cost. I went to another doctor to work on my other knee (same surgery) and had no problems with BC/BS of IL. Everything flew right through without any problems. I've found the same to apply for different hospitals as well. There is a certain hospital in our area that everyone complains about with claims. There are others that seemingly have fewer problems with getting claims processed. It is good to have freedom of choice in these situations.
It comes down to who one can trust to cross the 'T's and dot the 'i's. I like the sausage. I do not need to see how it is made.
Re: After all the fuss, public health plan covers few
Just so all the facts are on the table, realize that if you are on the so-called "public option" and basically at that point insured by the federal government, you would face the same appeals process, if not slower and more unwieldy. In any process such as this, you would have to have the same type of appeals structure. Granted, maybe the focus shifts more toward finding a way to do every procedure under the sun for everybody, as it undoubtedly would because the profit motive is removed along with all financial accountability.
I would interject here that if what you really believe is that everyone should have a fundamental constitutional right to get whatever medical treatment they want and have it paid for by taxpayers then just say so.
Please realize that if you get denied all the way up the ladder under a govt program, you can't sue them unless the authorizing legislation specifically allows it. This happens all the time with social security benefits, veterans benefits, etc.
Also, consider whether one of the reasons that Alabama BCBS has such a good reputation is because they know the Alabama plaintiff bar is always around the corner waiting to sue them out of existence.
Re: After all the fuss, public health plan covers few
Quote:
TRUTIDE
I was swapped over from BC/BS AL to BC/BS of Illinois abouth 3 years ago and have seen no change. My wife still uses BC/BS of AL and we see no difference...
LOL - Well, BC/BS of IL is the worst insurance we have ever had. We get a rejected claim at least once per month, and almost never because the paperwork wasn't filled out properly. They refused to pay for a test procedure for my wife last year, saying that it was "unnecessary", even though my wife's doctor and two separate specialists said that it was necessary. I paid for the procedure out of my pocket, and they found and removed two advanced polyps from my her colon. We threatened to sue and BC/BS reimbursed us in full. You have no idea how bad they are. I hope you never find out.
What if we didn't have the thousands of dollars to lay out? My wife might be dead right now, or have advanced cancer.
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November 3rd, 2009, 07:34 AM
