Have You Had Trouble With Your Insurance Co. Paying Claims?

[leftyladyfrommo]

I' just curious how many people here have been affected by this.

I just started with Assurant - I am self employed - with a $1500 deductible and it costs over $300 a month. I had to certify that I don't have any illnesses and haven't had in the last 5 years. I'm lucky in that I haven't had any pre existing conditions.

But then I saw where 20/20 I think did a show on insurance companies that don't pay their claims. Assurant denied about 45% of claims. And they actually comb thru records to see if they can find anything in the last 5 years that would give them any excuse not to pay - I think this is mainly over larger claims.

So I started checking and found out that I think this is pretty typical of most companies. And the people like me who are self employed are the ones that take the biggest hit.

So now I have insurance but I'm afraid to use it.

[Fovea]

1. It's been such a nightmare

i can't e ven begin to talk about it.

[The Velveteen Ocelot]

2. This is normal. It's what they do.

SOP for insurance companies is to initially deny the claim, or at least make it tough for you to collect by demanding more information, forcing you to put a lot of work into pursuing the claim, even hiring a lawyer. They hope you'll just give up.

[triguy46]

5. Our clinic routinely gets denials and requests for ...

additional information. Information that was on the original claim. So we resubmit and usually get paid. its a way for them to delay payment by asserting that they didn't get a
"clean" claim. Happens all the time. We know why they do it, its just part of the game.

[Tierra_y_Libertad]

3. Federal Blue Cross/Blue Shield here. They've been pretty good.

The only problems we've encountered is clerical glitches involving "Preferred Providers" and just plain bookkeeping errors. Usually, cleared up with a phone call or a few phone calls.

And, we're getting old, so we've had to use them for some pretty spendy things.

Having been an Employee Assistance counselor I had to deal with a lot of insurance companies, and more than a few of them put all sorts of obstacles to anything that's going to cost them. Real horror stories in some instances with, in one instance, fatal results. And, in others, with what may have been fatal results.

[emilyg]

6. Senior Blue Cross here

No problems.

[1monster]

4. No, my insurance has been good about paying claims, but they are

leaving the state.

What I have a problem with is the hospital padding bills and billing for services that they will not verify.

My insurance company stands ready to pay their legitimate claims and has requested verification of the charges.

The hospital refuses to even take the calls of the rep they have assigned to the case. We sent a letter disputing the charges to the hospital with a request that they deal with the rep assigned to the case. No answer to our letter.

Instead, they have sent the unverified charges to a collections law firm with the threat to sue us if we don't pay...

on edit: out of 7600 some odd dollars, the hospital verified $96.00 and were promptly paid. I know these were pharmaceutical charges because they did this to us before. A pharmacist looked at the print out and told me there was no way the insurance company would pay out for the charges. He pointed out that he could get 2000 tablets of an Rx for what they charged for one.

It's not all insurance companies. It's deceptive billing. When I pointed that out to accounts receivable the first time, I was told, "We can charge whatever we want."