7 ms·

I hate insurance companies. For one, they refused to pay for pre-approved claims when my wife had cancer and was being treated at Stanford (We were double-insur

by MrTonyD 11y ago

I hate insurance companies. For one, they refused to pay for pre-approved claims when my wife had cancer and was being treated at Stanford (We were double-insured. Apparently, when you have two insurances, it is common for carriers to decline payments in the hope that the other insurance will pay it.) So my wife couldn't get out of bed and we literally had a stack of unpaid bills over a foot high and totaling over a half-million dollars. Another reason to hate them is what I learned from consulting for insurance companies. I've been told first-hand stories by claims-adjusters about how the fax machine is intentionally put on the other side of their building and the CEO's assistant goes by and throws out all the papers. (The have the sense not to question why that is done.) And they discover that anyone paying too many legitimate claims gets fired. And their doctor's "reviews" only exist to look for people who might die and have the family resources to sue, and to decline legitimate claims so that enough people give up on their insurance claims. They cry when telling these stories. Addendum: My wife lived - but the experience was more horrible than I have words to describe. And I'm fortunate that I could afford to hire a consultant to work with the insurance company billing. It took 2 years, but we got most of it paid. I eventually wrote a check for a few thousand dollars to try to undo the damage to my credit report. To this day, I'm not sure why I had to pay that money and why it took two years when I had "great" insurance through two companies.

meesles 11y ago
That's what happens when you make a for-profit business out of people's health, hoping the clients either never make a claim or that you can loophole your way out of saving some zeroes in a spreadsheet. Unfortunately, those zeroes could be the difference between your spouse living or dying. The underlying problem is a flawed healthcare system, but with even socialist countries' citizens starting to have to buy insurance to get the care they need [0], I'm skeptical any easy or relatively short-term solution exists. [0]http://reason.com/blog/2014/01/22/socialist-swedes-take-to-private-health http://reason.com/blog/2014/01/22/socialist-swedes-take-to-p...
artursapek 11y ago
Two years ago my wife and I were unable to get Aetna to pay for a home birth, even though we got it approved ahead of time. After months of futile phone calls where they basically kept me on hold for 30 minutes and then told me to fuck off, what finally got them to pay up was an angry tweet I wrote. I thought it was silly, but was advised to try it as a last resort by the midwife's billing assistant. Amazingly, they reached out and immediately paid for it in full when they saw the tweet. I wonder how many people never try what I tried, and simply never get their claims paid after getting filtered out by their phone network. Horrible system.
- epicureanideal 11y ago
  Exactly. Make a public fuss. I had a non-medical situation in which raising a public fuss resolved the matter quite swiftly when I had no other leverage.
- atomical 11y ago
  Another thing that works is finding the format for e-mail addresses at the company and then searching LinkedIn for employees. Then use the Reply All button after you CC the whole company. If they don't respond it means that they didn't get the e-mail. Keep trying.
- nommm-nommm 11y ago
  Aetna's phone support is a joke. You call them up and ask them a question and they just answer randomly. I call ask a question, they tell me yes. I call again 5 minutes later and ask the same question and get no. Even simple straightforward stuff like "is this doctor in your network."
- brianwawok 11y ago
  Currently in battle with Blue Cross Blue Shield. Complete garbage of the universe. Been through 2 rounds of appeals with people that tell me that I am right, but the guidelines say they can't help me. Guess time to fire up the angry tweets.
sna1l 11y ago
Medical insurance in the US doesn't make any sense. Insurance is supposed to be a hedge against a large risk, but in the US we use our medical insurance to pay for common visits and prescriptions. Everyone is so used to this model that it doesn't seem weird. Imagine if you used your car insurance to pay for gas. That would be ludicrous. No other "insurance" is handled in this manner.
- bobbyi_settv 11y ago
  > Imagine if you used your car insurance to pay for gas. That would be ludicrous. That's not ludicrous enough for me. Can the insurance be provided through my employer so that I'll need different insurance to pay for my gas if I switch jobs?
  - progressive_dad 11y ago
    Only if gas stations can charge ludicrously higher rates to your provider but lower it to something reasonable for uninsured drivers.
    - mcherm 11y ago
      No, that's backwards. The gas stations charge ludicrously higher rates to the uninsured drivers, but charge less than the wholesale price of gas to the providers. I think. I can't be sure because the price of gas isn't posted, and the gas station attendants don't even know the price. All you can do is pump it, then see what number pops up afterward. And everyone thinks this is "normal".
- ma2rten 11y ago
  Car insurance is worse actually. In the US if you have an accident with bodily injury the settlement can go in the millions, but the legal limit for car insurance is as low as 20k. They do the opposite of what insurance should do, hedge against a small risk and leave you unprotected from big risks.
  - 11y ago
marincounty 11y ago
I'm sorry. I think their are fixes, but the average American doesn't seem to want change. All these big corporations need to do is throw some money at advertisers, create a little scare--almost always just a scare tactic. Like there will be Death Squads, or we will have to wait six months for a MRI, and the people just cave in, and say no to any changes. Again, I'm sorry about your wife.
- EliRivers 11y ago
  Oh yes, the "death panels" nonsense. I remember that bullshit. These insurance companies already are death panels, by design. They have a big pile of money and they get to keep every penny they don't spend on someone's healthcare. Of course they're a fucking death panel. Their business model is letting the most people die without it becoming so obvious that people stop giving them money.
  - maxerickson 11y ago
    There is now the 80/20 rule: https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-... They have to spend 80% of premiums or give money back. This is supposedly a cost control, but it isn't clear to me that it provides the right incentives (the easiest way for an insurance company that hits the rule to increase their profits is to raise premiums...).
    - MrTonyD 11y ago
      Having worked for Fortune 50's for most of my life, I'm not optimistic about that law. There are so many ways to adjust accounting that it is just amazing. And every company uses many offshores these days - they provide services and costs to get profits offshore. And they provide "services" that can be classified in any way they want. Really, that law sounds like just another deception for the masses who don't really understand how the system works for the rich.
      - EliRivers 11y ago
JohnTHaller 11y ago
Medical insurance in the US is absurdly corrupt. Fun fact, health insurance companies are exempt from most anti-trust laws. Health insurance companies are free to collude on price and split up states between each other to limit competition.
- thaumasiotes 11y ago
  > Health insurance companies are free to [...] split up states between each other to limit competition. Aren't health insurance companies legally prohibited from operating in more than a single state?
  - jacalata 11y ago
    I think they are just restricted to selling each policy in one state - but they can have 50 policies, one for each state.
epicureanideal 11y ago
The people who cry when telling work stories from insurance companies should seriously quit and preferably go to the media about why. I really don't doubt that if they asked for $1 on the media they'd get much more than their salary back for exposing this nonsense.
- MrTonyD 11y ago
  The insurance companies are careful not to do anything illegal. Declined reviews and firing people and "losing" paperwork can all be explained away. I spoke to an attorney after doing work for a couple of insurance companies -- and asked how they could get away with the things they were doing. He explained to me that their endless review process is really a way to stay out of court almost indefinitely. Apparently, there is some legal concept that if 2 parties are still in the process of working out a resolution (there are more reviews which can be done), then the case will be thrown out until the process is completed. So those reviews are really there to prevent you from ever getting a claim resolved. This is all legal (and I would argue created by our government which has been purchased by lobbyists.) So some low-paid claims adjusters losing their job for no reason really makes no sense. The corrupt insurance industry has been reported-on in books, movies, and articles for my entire life.

by MrTonyD 11y ago

meesles 11y ago

That's what happens when you make a for-profit business out of people's health, hoping the clients either never make a claim or that you can loophole your way out of saving some zeroes in a spreadsheet. Unfortunately, those zeroes could be the difference between your spouse living or dying. The underlying problem is a flawed healthcare system, but with even socialist countries' citizens starting to have to buy insurance to get the care they need [0], I'm skeptical any easy or relatively short-term solution exists. [0]http://reason.com/blog/2014/01/22/socialist-swedes-take-to-private-health http://reason.com/blog/2014/01/22/socialist-swedes-take-to-p...

artursapek 11y ago

Two years ago my wife and I were unable to get Aetna to pay for a home birth, even though we got it approved ahead of time. After months of futile phone calls where they basically kept me on hold for 30 minutes and then told me to fuck off, what finally got them to pay up was an angry tweet I wrote. I thought it was silly, but was advised to try it as a last resort by the midwife's billing assistant. Amazingly, they reached out and immediately paid for it in full when they saw the tweet. I wonder how many people never try what I tried, and simply never get their claims paid after getting filtered out by their phone network. Horrible system.

epicureanideal 11y ago
Exactly. Make a public fuss. I had a non-medical situation in which raising a public fuss resolved the matter quite swiftly when I had no other leverage.
atomical 11y ago
Another thing that works is finding the format for e-mail addresses at the company and then searching LinkedIn for employees. Then use the Reply All button after you CC the whole company. If they don't respond it means that they didn't get the e-mail. Keep trying.
nommm-nommm 11y ago
Aetna's phone support is a joke. You call them up and ask them a question and they just answer randomly. I call ask a question, they tell me yes. I call again 5 minutes later and ask the same question and get no. Even simple straightforward stuff like "is this doctor in your network."
brianwawok 11y ago
Currently in battle with Blue Cross Blue Shield. Complete garbage of the universe. Been through 2 rounds of appeals with people that tell me that I am right, but the guidelines say they can't help me. Guess time to fire up the angry tweets.

sna1l 11y ago

Medical insurance in the US doesn't make any sense. Insurance is supposed to be a hedge against a large risk, but in the US we use our medical insurance to pay for common visits and prescriptions. Everyone is so used to this model that it doesn't seem weird. Imagine if you used your car insurance to pay for gas. That would be ludicrous. No other "insurance" is handled in this manner.

bobbyi_settv 11y ago
> Imagine if you used your car insurance to pay for gas. That would be ludicrous. That's not ludicrous enough for me. Can the insurance be provided through my employer so that I'll need different insurance to pay for my gas if I switch jobs?
- progressive_dad 11y ago
  Only if gas stations can charge ludicrously higher rates to your provider but lower it to something reasonable for uninsured drivers.
  - mcherm 11y ago
    No, that's backwards. The gas stations charge ludicrously higher rates to the uninsured drivers, but charge less than the wholesale price of gas to the providers. I think. I can't be sure because the price of gas isn't posted, and the gas station attendants don't even know the price. All you can do is pump it, then see what number pops up afterward. And everyone thinks this is "normal".
ma2rten 11y ago
Car insurance is worse actually. In the US if you have an accident with bodily injury the settlement can go in the millions, but the legal limit for car insurance is as low as 20k. They do the opposite of what insurance should do, hedge against a small risk and leave you unprotected from big risks.
- 11y ago

marincounty 11y ago

I'm sorry. I think their are fixes, but the average American doesn't seem to want change. All these big corporations need to do is throw some money at advertisers, create a little scare--almost always just a scare tactic. Like there will be Death Squads, or we will have to wait six months for a MRI, and the people just cave in, and say no to any changes. Again, I'm sorry about your wife.

EliRivers 11y ago
Oh yes, the "death panels" nonsense. I remember that bullshit. These insurance companies already are death panels, by design. They have a big pile of money and they get to keep every penny they don't spend on someone's healthcare. Of course they're a fucking death panel. Their business model is letting the most people die without it becoming so obvious that people stop giving them money.
- maxerickson 11y ago
  There is now the 80/20 rule: https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-... They have to spend 80% of premiums or give money back. This is supposedly a cost control, but it isn't clear to me that it provides the right incentives (the easiest way for an insurance company that hits the rule to increase their profits is to raise premiums...).
  - MrTonyD 11y ago
    Having worked for Fortune 50's for most of my life, I'm not optimistic about that law. There are so many ways to adjust accounting that it is just amazing. And every company uses many offshores these days - they provide services and costs to get profits offshore. And they provide "services" that can be classified in any way they want. Really, that law sounds like just another deception for the masses who don't really understand how the system works for the rich.
    - EliRivers 11y ago

JohnTHaller 11y ago

Medical insurance in the US is absurdly corrupt. Fun fact, health insurance companies are exempt from most anti-trust laws. Health insurance companies are free to collude on price and split up states between each other to limit competition.

thaumasiotes 11y ago
> Health insurance companies are free to [...] split up states between each other to limit competition. Aren't health insurance companies legally prohibited from operating in more than a single state?
- jacalata 11y ago
  I think they are just restricted to selling each policy in one state - but they can have 50 policies, one for each state.

epicureanideal 11y ago

The people who cry when telling work stories from insurance companies should seriously quit and preferably go to the media about why. I really don't doubt that if they asked for $1 on the media they'd get much more than their salary back for exposing this nonsense.

MrTonyD 11y ago
The insurance companies are careful not to do anything illegal. Declined reviews and firing people and "losing" paperwork can all be explained away. I spoke to an attorney after doing work for a couple of insurance companies -- and asked how they could get away with the things they were doing. He explained to me that their endless review process is really a way to stay out of court almost indefinitely. Apparently, there is some legal concept that if 2 parties are still in the process of working out a resolution (there are more reviews which can be done), then the case will be thrown out until the process is completed. So those reviews are really there to prevent you from ever getting a claim resolved. This is all legal (and I would argue created by our government which has been purchased by lobbyists.) So some low-paid claims adjusters losing their job for no reason really makes no sense. The corrupt insurance industry has been reported-on in books, movies, and articles for my entire life.