[NA] Good news phone call

gkainz

gkainz

Final Approach
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Feb 23, 2005
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Arvada, CO
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Greg Kainz
Some may recall earlier my sad tale of getting jerked around by my health insurance carrier in their refusal to pay for a surgery last fall, first citing "pre-existing conditions" to which my doc wrote them a "hey morons, any third-grader will poke holes in your 'pre-existing condition' stance" and then recinding my policy based on "material misrepresentation on the application" to which my doc wrote another letter telling them they were completely off-base and debunked each and every point. Well, yesterday I received another letter denying further payment on followup procedures, once again citing 'pre-existing condition'. However, I just got a call from my agent's representative telling me that the insurance company has reversed their decision on the surgery and will pay the outstanding claims. WhooHooo! :dance: One battle down, one to go!

"Our records indicate that you have had one or more flat tires on your car in the past 2 years. As such, we are unable to pay your claim for a blown head gasket and defective radiator, as we have determined that pre-existing conditions exist prior to the effective date of your maintenance agreement"
 
Have you called your state insurance commissioner about this company's practices? If they're doing it to you, they're doing it to others.

Anyway thats good news about the surgery!
 
Glad to hear it, Greg!

Wouldn't "pre-existing conditions" indicate "before existing"? How can you have "pre-existing conditions" if they didn't exist before they were conditions??
 
Greebo said:
Have you called your state insurance commissioner about this company's practices? If they're doing it to you, they're doing it to others.
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The CO state insurance commissioner's website states that one has to go exhaust the insurance company's review process and mediation board before bringing a complaint to them. Basically, "use all means possible to resolve before coming to us with it". I did find a few other case citations across the country of decision reversals from this company in my research. I've heard from others inside the industry that the guideline is "deny all claims and pay those that get contested long enough and hard enough".
 
gkainz said:
"deny all claims and pay those that get contested long enough and hard enough".
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Yep, reminds me of the movie "The Rainmaker". You didn't buy street-surance did you?
 
Greg: Keep up the fight!! I can relate to you that persistance does indeed pay off. My wife had a major medial expense a few years ago and the carrier denied her valid claim. Her primary care doc supported her her specialist backed her up and the carrier played hard ball. I fought for over a year and the carrier kept playing games with me. They requested the same documentation numerous times. They kept saying they didn't get certain bills when I know they did because I sent them certified mail. They would send bills back to me and tell me I needed to get a new bill that had the Physicans name and address on it with the procedure or Rx and with the amount paid, Of course the bill I sent them had all that on it all ready. The runaround I got was amazing and I'm a lawyer.

We know people in the insurance industry and they have related to us that they are told to deny deny deny and a vast majority of claims denied something like 80% will go away. Greg do not go away you must be a thorn in their side. Two magic words to use with an insurance carrier who is not paying a valid claim are " Bad Faith" Keep up the good fight and DO NOT give up!!!
 
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Wow! Thanks, Adam. I consider myself lucky that they reversed their decision with only 2 review processes after hearing your story!
 
woodstock said:
insurance companies are evil. glad you are taken care of Greg!
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Elizabeth,

What would it take for you to reconsider your stance on this?

While Greg's ordeal is indeed a real problem, I can just as easily counter it with a story where insurance was useful and beneficial to the policyholder.


-Rich
 
Let'sgoflying! said:
Sounds good Greg but get it in writing from the agent?
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The letter is supposed to be forthcoming... holding my breath. Hope it's not a "check's in the mail" story...
 
I believe there's some truth in both of the statements above. The problem, as I see it, is that we, the consumer, treat health insurance like a pre-paid blanket maintenance policy, instead of a catastrophic "insurance" policy. If auto insurance were treated the same way, we would expect the insurer to cover oil changes and tire repair, and had better expect to pay way more than we are now for this service. However, in my research for a major medical policy, the price difference was not that great, so there was little motivation to switch. I did, however, get a high-deductable policy backed with an HSA. But for an emergency surgery, I would be far ahead when compared to a standard HMO or PPO.
(Man I hope I don't get charged extra for all the commas above!)
 
woodstock said:
insurance companies are evil. glad you are taken care of Greg!
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It's just numbers and business to them, nothing personal. They will pay according to policy limits, but often have to be astutely reminded to do so.
 
AdamZ said:
. . . and I'm a lawyer.
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Oh now you've done it, you outed yourself.

There are two types of pilots -

Those who hate all lawyers - end of discussion:

Until theywant to:

buy an airplane,
sell an airplane,
defend themselves from an enforcement action,
divorce their spouse,
buy a house,
get redress for their kid whose in traction,
start a company,
sue a company,
prod a government agency to action,
breakthe law,
change a law,
fight an unfriendly neighborhood faction.

I could go on.


And those who have no use for lawyers since after all pilots can read and think.

Until they:

Mess it up themselves and need an attorney to fix it for them - I like these the best, they have fire in their bellies and know whatever I charge them it is less than the cost of the mess if it doesn't get fixed up. At the end they they often say - Gee, I could have done that myself. Sigh.

There are a few who will respect you for being a professional, but they are few and far between.

Oh well Adam, now you're out here as well as at the other board.
 
gkainz said:
The CO state insurance commissioner's website states that one has to go exhaust the insurance company's review process and mediation board before bringing a complaint to them. Basically, "use all means possible to resolve before coming to us with it". I did find a few other case citations across the country of decision reversals from this company in my research. I've heard from others inside the industry that the guideline is "deny all claims and pay those that get contested long enough and hard enough".
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I've had similar experiences with insurance, especially medical insurance. I think they have a standing policy at most HMO's to deny and/or stall re-imbursement as long as possible as a way to "lower medical costs". They are also in the habit of trying to coax you to give someone up as being responsible for your "condition" that they can seek recovery from.

WRT the state insurance commission, I think the requirement of exhausting all other avenue's before going to them only applies if you are looking to the IC for help in resolving something. If you just want to point out lousy tactics by an insurer, you should be able to go to them at any time. One would hope that if they got enough complaints they would pursue some kind of improvement.
 
Arnold said:
Oh now you've done it, you outed yourself.

There are two types of pilots -

Those who hate all lawyers - end of discussion:

Until theywant to:

buy an airplane,
sell an airplane,
(snip)

And those who have no use for lawyers since after all pilots can read and think.

Until they:

Mess it up themselves and need an attorney to fix it for them - I like these the best, they have fire in their bellies and know whatever I charge them it is less than the cost of the mess if it doesn't get fixed up. At the end they they often say - Gee, I could have done that myself. Sigh.

There are a few who will respect you for being a professional, but they are few and far between...
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Arnold:

My favorites (not!) are the ones who tell you, "I don't care what its costs, it's the principle!" Nature's way of telling you to run away, because in my experience, when they say, "I don't care what it costs...," they *mean*, "....because I won't pay my bill, anyway."

I could not trust a business person who does not care what it costs. Successful businesses I represent are headed up by people who know what EVERYTHING costs, and they care very much.
 
SCCutler said:
Arnold:

My favorites (not!) are the ones who tell you, "I don't care what its costs, it's the principle!" Nature's way of telling you to run away, because in my experience, when they say, "I don't care what it costs...," they *mean*, "....because I won't pay my bill, anyway."
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That's because they probably don't put the word "me" after costs. IOW they don't care what it costs someone else.

Way more than half the lawyers I know are pretty decent people, but some others I know are snakes IMO. AFaIK they're all good sources for lawyer jokes.
 
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