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Originally Posted by PaulS
Sounds like you didn't read your policy cause if they denied a claim for something that was in the policy you'd certainly have a winable suit. Your also saying that they should be forced to take what they consider to be bad risks - what other professions is required to take business that they will loose money on. Ask a dr. to do something for free and you can laugh your way to the funeral home. Since your such an expert you should start a classless action suit. As I said before, if you don't like insurance, drop all of your elective coverage. Your the one who sounds like a dirtback with the language you use.
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OK, this was my first look-see and post in the grumpy ol pharts board and will be my last. This is not the place for me, I'll stick to fishing subjects. Without getting too raunchy let me first apologize in advance to de-railing the topic at hand…
I don't know if you ever read a full company health plan but there is a lot of "grey" area and much of it is subjective interpretation by the ins. Co’s. themselves. Slick lawyers wrote it and slicker salesmen pitch it. Anyway, how come when it comes to insurance companies, it always has to come down to law suits and legal threats to receive payment? Herein lies a part of the problem.
As to your comment about Dr's.... Now YOU are taking out of your backside. You are talking to the wrong guy cause I have enough free-care tails to overflow this machine. The amount of "free" or "unpaid" care hospitals and docs perform is mind-boggling. You have no idea. When was the last time you saw a hospital kick a pregnant mother with problems who is in labor out into the street and say sorry, your on your own, you have no insurance? Its almost funny how an illegal alien and their family with no cash and no insurance gets treatment when they walk in the ER door at any hospial. Who eats that? Certainly not the insurance company. Non-payers probably will not get an elective boob job but I bet a heart, cancer or spinal chord operation will be “absorbed by the system” somehow when they get in a car crash and walk in the ER. The first words illegals learn to speak when they walk into a hospital is "free care". When was the last time an insurance company gave you a free policy? Yeah you give to some charities and golf tourneys but in general the word “free” and insurance don’t go together.
I've seen docs and hospitals rally behind some amazing cases where insurance companies bailed on the patient. How about a young pregnant woman with 2 young kids and is diagnosed with very serious breast cancer and needs chemo right way, the mother will probably die and the unborn baby is in trouble. A lot of medical care has to be done just to keep anyone alive. Her husband who just lost his job is stunned with what is happening to his life what is happening to his wife and all the insurance company can do is heap on more problems for this poor guy and his family. There was a meeting and the hospital and docs ate all the costs. It was big bucks and lots of time. I have a hundreds of stories like this. I repeat, insurance companies suck because they are suppose to insure EVERYONE not skim off the problem cases and only take the low riskers, EVERYONE needs to be in the pool.
Fact is, Insurance payments to docs and hospitals over the years have been getting smaller and smaller and smaller and have fallen back to gov't minimums in most cases. You have culled out the higher risk and left them to “the system”, while you skim the cream off the top of the paying pool. Further, the approach most ins companies seem to take is to deny everything, let them fight for it and only pay the outright minimum only when forced to after long battles. Let them sue us is the common tone I hear, even you echoed that. They muscle docs and hospitals to sign one sided payment agreements or they don’t deal with them. Hospitals and docs have little choice. Get something or be faced with eating it all because you can’t turn them away by law.
Businesses are faced with a 20%+ increases in health insurance premiums year after year...and a take it or leave it attitude from the insurance companies. Many large businesses have decided to self insure and cut them out all together and just pay the health care costs for their employees, can’t blame them but it is further putting more pressure on the small business owner. The way I see it, the system is designed so that insurance companies set their premiums, set the amount they pay back to the health care providers and let the system (other people) do as much cost shifting as possible to minimize their end. They control all ends with few limits. I use to live next to a fellow who had a real monster of a house and he and his wife both drove a new Benz and lived a pretty sweet life, he sold health care insurance to companies. I ask you, does this seem right? Is selling insurance that profitable where the salesmen live like that? (Granted that was RI and he probably had was running an insurance scam of some kind.)
My point is, talk to any family who has suffered the loss of a loved one with a serious illness and had to deal with the red tape, fine print and interpretation hassles of the policy by insurance co at a time when they really don’t need more hassles and have the company turn around and say...if you don't like it sue us. People dread having to deal with them yet we are forced to deal with you. Ins companies know most people don't have the resources, time or desire to sue a big company, they just want prompt full payment for their incurred costs with a little compassion. Those who do sue, even if they win, incur large legal fees and although paid for by the insurance company, the whole thing results in yet larger premiums for the end user. It is a no win situation for the payee.
I can’t tell you how many times I have seen a small partial payment made by the ins co and the doc or hospital cannot bill for the remainder, because under their agreement they can’t. Who eats that? If they didn’t sign the agreement they got nothing. What kind of business can operate like that? Or, some element of the paperwork is quietly missing and payment gets delayed beyond the 3-month window you have to collect, and they get nothing. There are a million games insurance companies play you can't keep up with them. You need an entire trained office staff just to collect some fee from insurance companies… Even further rising the cost to the end user.
I think in my lifetime we will see a complete implosion in the current insurance business, as soon as enough people get thoroughly disgusted….we are getting closer every year…a few more terrorist attacks, hurricanes and a national health crisis should do it . Ever wonder how much money ins co's spend just in TV ads to boost their failing public image?
End of insurance rant I got to get back to work.
BTW what is a "dirtback"?
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