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Health Insurers...

Discussion in 'Tilted Philosophy, Politics, and Economics' started by Tully Mars, Nov 10, 2013.

  1. Tully Mars

    Tully Mars Very Tilted

    Yucatan, Mexico
    We have an Obamacare/ACA thread but I'm interested in how large health insurers are responding to the act. Many it seems are resorting to scare tactics, misleading and flat out lying to customer.As this piece points out-

    --- merged: Nov 10, 2013 at 12:33 PM ---
    Turns out they don't like being forced to actually provide coverage. Who knew? Seriously raise your if this surprises you. For years we've heard, read and in some cases (like me) personally experienced what happens when your health care actually starts costing your insurer money. I do not think the ACA is the end all be all law it could have been but it's better then what we had which was health insurance companies denying claims for BS reasons, slow paying, finding stupid reasons to drop people only after they get injured or ill. Myself I had a leg/foot injury that resulted in some nerve damage. My insurer at the time , Cigna, first covered my treatments and I paid a simply and clear co-pay. After a year and a half my doctor referred me, through my plans network, to a specialist who recommended a fairly new but widely accepted spinal procedure. At first Cigna simply called it "experimental" and therefore not covered. My doctor phone them and wrote them explaining it was not experimental because (insert some lingo here I didn't/don't understand.) More or less I was, as a patient, left out of the back and forth that took place. About 45 days later the clerical from my specialists office phone to me say "Cigna approved your surgery. Are you still interested in having it?" "If the Doc thinks it'll help of course." We scheduled the procedure. On the morning I arrived, having fasted the day prior, I was informed Cigna had not sent or at least the hospital had not received the forms approving payment for my treatment. I asked "so, we cancel and try to reschedule?" "Give us a 1/2 hour to see if we can get it via fax." "Ok." about an hour ans forty minutes later they called me up and said they had the approval. Good I was getting hungry. Had the procedure and left that afternoon. thing went fine but the surgery didn't help as much as I'd hoped but it likely stopped my problem from getting worse. Two month pass and one day I receive a bill from the hospital for a little over 30K. No mention of "this has been submitted to your insurer..." just this is the amount you owe please send you payment within 30 days. I called and was told Cigna turned down the claim. I told the lady in billings that Cigna had approved it, I had to wait for the approval, doctor wouldn't do it until he got approval. A lot of back and forth over the next few weeks and in the end both the hospital and Cigna agreed I was on the hook and needed to pay it. Why? Mainly because Cigna said the hospital used a code for "in office treatment" rather then "in hospital." I spent months and a couple K on an attorney only to have the hospital report I was in default to the credit agencies. The attorney, after collecting her fee said "well, I've written several letters (letters I could have written my damn self) and both Gigna and the hospital agree on one thing... it's your responsibility. sorry I could be more help. Please call me in the future if yu have other legal needs, thank-you." Thank-you? I thought, more like screw you. I ended up getting a HELOC on my house and thanks to the hospitals reports to the credit agencies I ended up with a crappy rate.

    From what I've read this type of BS will ot be allowed under the ACA. Jon Stewart had some news clip where some guy had insurance through his work for years but when he became seriously ill the insurer dropped him because he failed to report a spider bite from several years back.

    So we're getting the news about all the bad things happening to some people, which probably does suck, but how many people out there have stories where the way it was was way worse I wonder.
    Last edited by a moderator: Nov 17, 2013
  2. redux

    redux Very Tilted Donor

    Foggy Bottom
    Historically, health insurance has been regulated at the state level and focused primarily on the solvency of the insurance companies and the ability to pay claims, with lesser attention on underwriting and market practices of those companies or any stringent consumer protections. And that is why the individual market has so many junk plans or as Consumer Reports found:
    Another result of the lack of strong and consistent regulations across all the states was identified in testimony several years ago by a former health insurance executive:
    There have been several attempts over the years to enact a "patients bill of rights" with strong(er) federal consumer protections...a McCain/Kennedy bill passed in the Senate in 2001 and died in the Republican House.

    Instead, Republican health reform proposals since then have focused on providing health insurance across state lines, the likely result being that insurance companies will domicile in the states with the least regulations and the least consumer protections and then sell nationwide under those lax regulatory standards.

    Health care should not be a state issue; it should be a right, with strong federal protections for all Americans.
  3. Tully Mars

    Tully Mars Very Tilted

    Yucatan, Mexico
    My state did a horrible job of regulating health insurance in my opinion. When I contacted the Insurance Division of the state of Oregon's Dept. of Consumer and Business whatever they more or less said "Oh, well you know these things happen and.. well have you contacted an attorney because it sound like they haven't followed the contract." No kidding? And what is your job exactly?
  4. rogue49

    rogue49 Tech Kung Fu Artist Staff Member

    Snake oil salesmen.

    I've experienced my own "fun & games" with insurers.
    They look out for themselves.

    And god forbid if you actually ask them to cover what you've been paying for. (what your company is paying for too)

    Even now, a couple of years into the ACA...I just received "pre-existing" denial.
    Which I thought to be illegal now.
    And a bonus...they don't even tell me what I submitted for or what exam. Just that I'm declined for $500.
    And so...I have to start "the chase" again.

    Now fortunately, I'm now smart enough to know how to chase...and to have a flex-spending plan to cover these unplanned "costs".
    But this shows you how pervasive the issue is...this is just the tip of the iceberg...and how long it will take to get it out of our system entirely.

    It's a shame that this kind of scam even existed.
    But there have been fleecings of these throughout history.
    Which is WHY we have laws and regulation.

    Laissez faire sounds nice...in theory...but in reality, there are too many taking advantage of citizens.
    If you inclined to worry about fraud from citizens abusing the system...then you have to ALSO worry about the system harming our citizens.
    The law is equal...or at least it is supposed to be.

    We cannot go back to what we had before.
    There is still a long way to go.

    And again, if you disagree...then come up with a DAMN alternative.
    Because I haven't heard ONE from any conservative I've asked personally.
    They just say "I don't know" :rolleyes:

    And nor has any other insurer.
    And they really haven't done anything more than take more of the money and doing a fine job of CYA.
    Last edited: Nov 11, 2013
  5. Tully Mars

    Tully Mars Very Tilted

    Yucatan, Mexico
    From the contact I've had with insurer I believe they're giving me BS answers and pounding away with the 'thank the ACA for that' answers. I live in Mexico and buy insurance here at a reasonable cost. I have a per-existing condition, it's not life threatening, but could cost an insurer a few K a year just in Rx's. My insurer here (Sub of Citi Group) signed me up but told me for the first five years I was on my own for anything related to my pre-exist. This September I pasted that five year mark. I submitted my receipts for several hundred dollars in Rx's for Sept. and last Friday they direct deposited the portion (minus co-pay, $5+/-) for them into my Banamex account.

    Now my mother lives in Salem, Or and since my fathers passing a couple years back I've been traveling rather regularly up to see and help care for her. I'd like to get on a plan with the ACA since my insurance here will not cover medical costs in the US, specifically, in big bold letters, states it will not cover any medical services provided in the US. Several other countries including Canada would be covered. Not the US, d'uh the US' health care costs are insane. So I may or may not be interested, as my mother ages, in spending more time in Oregon. Right now Oregon's web site is not up, says it will go on-line in shortly but you can call and talk to providers and the state operated exchange employees. When I call providers I'm told things such as "no, you don't qualify, yes, your premiums will be 1000's a month. No, your preexisting will to be covered etc.." When I speak to the exchange employees they tell me that's pretty much all crap. Their only concern is am I a resident? Which I understand could be a legit issue. Since I pay Oregon taxes, vote in Oregon and carry an Oregon drivers lic. I believe and they are checking I can qualify as a resident for the exchange purpose. If not I'll understand. But this BS the insurer are telling me (granted it not all) is nothing but standard scare tactic crap in my opinion.

    Based on my experience and the articles detailing others having the same response from insurers I think the health insurance industry is purposely and successfully launched a PR campaign to convince folks the ACA sucks and the campaign is largely based on BS and lies.
  6. rogue49

    rogue49 Tech Kung Fu Artist Staff Member

    Classic propaganda tactics.

    Let's put it this way, if they were so great...then there wouldn't be a need for the ACA.

    Problem is, you don't have much choice other than what your employer decides to use.
    Sure, you could go outside of that...but then it would be all on you.

    And often, your employer is looking to save money...not benefit their employees.
  7. redux

    redux Very Tilted Donor

    Foggy Bottom