Who is your Health Insurance Co?

StoneHeartFarm · Feb 10, 2002

frank_f15

<font color=blue> make sure its a real heart attack. </font color=blue>

I believe you have hit the situation my wife desribes as: "If they're going to hire Chimpanzees they should train them better!" This is usually said in a fairly loud voice as she is hanging up the phone or exiting the door. /w3tcompact/icons/laugh.gif

SHF

cowboydoc · Feb 10, 2002

SHF,
What are you looking for the plan for? Individual, company? Also do you own a company, incorporated, etc. Depending on these I can help you out more on your best options.

StoneHeartFarm · Feb 10, 2002

Cowboydoc,

Just popped you a private message. Thanks for the help. Between you and Dave maybe I can get this figured out.

SHF

TBone · Feb 11, 2002

Like some others, the corporation I work for is self insured but United Health Care is the administrator (they decide which bills to pay, which ones to reject, how much is a fair charge, etc).

For the most part they are pretty good. They never lose a claim and usually respond fairly quickly.

I have, however, had some very serious disagreements with them. My son had a kidney stone and was taken to the emergency room one weekend. He was given something for pain and sent home. He later passed the stone. UHC said it was not an emergency. If you have ever had a kidney stone I think you might disagree.

I had some blockage in the arteries going to my heart and was admitted for observation the first time I had chest pains. They kept me 23 hours and dismissed me for some further outpatient tests. The tests showed a 95% blockage and two angioplasties and stents were done. UHC refused to pay for the first hospitalization because it was not a "real" heart attack and they kept me less than 24 hours. It was considered a "cautionary observation" and they didn't want to pay. (After MUCH wrangling, they finally did)

Another time I was severely bitten by a dog and they refused to pay the office visit because they said it wasn't an accident, that the dog had done it on purpose. I told them it might not have been an accident on the dog's part but it sure was on mine. They finally paid that one as well.

I DO NOT LIKE INSURANCE COMPANIES!

frank_f15 · Feb 12, 2002

u have to look at it from the insurance companys point of view/w3tcompact/icons/crazy.gif. now that dog new your tbn name was TBONE, and of course dogs love to chew on TBONES, so of course the dog chewed on u , ON PURPOSE!!!!!! /w3tcompact/icons/clever.gif i not only dislike ins.companies! i detest them.

DocHeb · Feb 12, 2002

Just remember what business your insurance company is running. Most people think that insurance companies are in business to pay for your health care.

THEY ARE NOT IN THAT LINE OF WORK!

They're actually in the business of not paying for your health care. The more they don't have to pay, the better their business is doing. Any claim they can deny - for whatever reason - the better.

There have been some companies in Michigan that have denied 30% of claims right off the top, even though they know the claims may be legitimate. This lets them float the money longer without having to pay.

Alan L. · Feb 12, 2002

We have Blue Cross Texas and it has been very good. However they have raised our premiums by 60% 2 years in a row, so we are now looking at a Pacific Care policy with not near as good a coverage.

TerryinMD · Feb 13, 2002

DocHerb,

Now that is one of the best reasons I've heard yet!! Floating the money.... Doh!!! /w3tcompact/icons/shocked.gif

Terry

Anonymous Poster · Feb 14, 2002

Things that scare me; Insurance co. , Banks , Drug co., I am all for capitolism but these guys are out of line. I am old enough and have paid enough attention to politics now to know, that what they taught me in high school was a crock of crap.

cowboydoc · Feb 14, 2002

The thing that makes me the maddest is the way these guys make their money is two way. One they put off paying claims as long as they can. They arbitrarily take 20-40% of the claims each month and toss them out for no reason. Perfect example. With BC/BS 20% of our patients every month their claim is denied b/c the ins. comp. sends them a letter saying that the claim turned in may have been work related or accident related. They give the patient a form to fill out and send back in. Well usually the pt. thinks that it's our resp. and throws it away. Well the ins. comp. won't pay until the patient sends that in. So usually it's 2-4 months before they will finally send it in. Even if they send it in right away I have to wait 60-90 days for my money in addition to the 30 days for a normal claim.

The ins. comp. makes money by taking your money paid to them for premiums and invests that money. So the longer they can not pay claims the more money that they make. I've talked before about how they force us to play these numbers games to keep prices going up so they can tell you that the cost of healthcare keeps rising. It's a huge game and it's not right.