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Thread: Insurer agrees to pay medical bills after Twitter showdown

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    Re: Insurer agrees to pay medical bills after Twitter showdown

    Quote Originally Posted by solletica View Post
    Insurance companies all have an (unofficial) poicy of repeatedly denying legitimate claims and offering bonuses to staff that do. In fact, for all practical purposes, medical insurance in the US is totally useless because of that fact.

    A law needs to be passed that allows patients to sue insurers and force those insurers to pay the legal costs of the suit to the patient when losing.
    Medical insurance in the United States is far from useless. Every state has an insurance regulatory bureau who is more than happy to help unsatisfied customers who think their claims are unjustly denied.

    Some consumers are too stupid to know what they're buying. When they see an ad on TV that says, "Health insurance for $25 a month" --- they're just dumb enough to believe it.
    The devil whispered in my ear, "You cannot withstand the storm." I whispered back, "I am ​the storm."

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    Re: Insurer agrees to pay medical bills after Twitter showdown

    Insurance companies do try to deny legitimate claims, but mostly they use the same system governments do, having medical professionals analyze claims. The difference is that if a greedy private company denies a claim, it's headline news, but if a benevolent national health service does it, then it's a victory for social justice.

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    Re: Insurer agrees to pay medical bills after Twitter showdown

    Quote Originally Posted by MaggieD View Post
    Medical insurance in the United States is far from useless. Every state has an insurance regulatory bureau who is more than happy to help unsatisfied customers who think their claims are unjustly denied.
    That bureau is typically the state's Dept. of Commerce or some similar organization. And their power is significantly limited in cases where the denials are made in violation of the insurers' policy and law but the legality of that denial isn't immediately obvious, i. e. a policy that claims to cover breast cancer screening that then denies coverage for mammograms done in excess of once every 5 years, or that denies coverage for MRI exams outright (even when such a screening would be medically recommended over a mammogram).

    Lawsuits that force the losing party to pay are the only way to enforce the insurance contracts. Without them, the insurance contracts are worthless (as just demonstrated in my example).

    Quote Originally Posted by MaggieD View Post
    Some consumers are too stupid to know what they're buying. When they see an ad on TV that says, "Health insurance for $25 a month" --- they're just dumb enough to believe it.
    Frankly, any consumer that bought an insurance policy and expected the insurer to consistently abide by its policy is dumb.

    Until insurance company lawsuit reform is in place, consumers should not enroll in any policy. It would be cheaper and simpler for them to simply cover all medical expenses out-of-pocket thru private negotiation w/doctors they trust. FYI, cash fees negotiated with a doctor tend to be significantly less than what that doctor (and his clinic) would bill the insurer.

    The only people who could possibly benefit from health insurance are

    1) Lawyers who have expertise in health insurance law
    2) Those who have connections and/or affordable access to such lawyers
    Last edited by solletica; 08-06-12 at 11:39 PM.

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    Re: Insurer agrees to pay medical bills after Twitter showdown

    Quote Originally Posted by francois60 View Post
    Insurance companies do try to deny legitimate claims, but mostly they use the same system governments do, having medical professionals analyze claims. The difference is that if a greedy private company denies a claim, it's headline news, but if a benevolent national health service does it, then it's a victory for social justice.
    Mostly correct but you failed to recognize that the private insurance cartel and the US government are one and the same. CIGNA, Aetna, etc. all lobby Congress to enact laws that allow them to maintain their monopoly without oversight.

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    Re: Insurer agrees to pay medical bills after Twitter showdown

    Quote Originally Posted by solletica View Post
    That bureau is typically the state's Dept. of Commerce or some similar organization. And their power is significantly limited in cases where the denials are made in violation of the insurers' policy and law but the legality of that denial isn't immediately obvious, i. e. a policy that claims to cover breast cancer screening that then denies coverage for mammograms done in excess of once every 5 years, or that denies coverage for MRI exams outright (even when such a screening would be medically recommended over a mammogram).

    Lawsuits that force the losing party to pay are the only way to enforce the insurance contracts. Without them, the insurance contracts are worthless (as just demonstrated in my example).



    Frankly, any consumer that bought an insurance policy and expected the insurer to consistently abide by its policy is dumb.

    Until insurance company lawsuit reform is in place, consumers should not enroll in any policy. It would be cheaper and simpler for them to simply cover all medical expenses out-of-pocket thru private negotiation w/doctors they trust.

    The only people who could possibly benefit from health insurance are

    1) Lawyers who have expertise in health insurance law
    2) Those who have connections and/or affordable access to such lawyers
    I believe every single state has (Your State) Department of Insurance whose responsibilities, among other things, are to make sure that policy promises are kept. If it's in the policy, your state's regulatory body will see to it that you're paid. Their penalties are damned strict up to and including barring a company from doing business in their state, massive fines and massive class action lawsuits.

    It's very important to keep the information brochures one receives when they sign up for a policy, read the paragraph headings within the policy that deal with how they pay claims...and read whole paragraphs when the paragraph heading applies to specific coverage.

    If you have an HMO policy? All bets are off. That's because they're much cheaper than PPO policies and require a doctor's okay for testing. Other than that? I think it's fair to say that people can count on their health insurance policies.

    I personally have had, probably, $120,000 in medical bills paid by my insurer. Never a question. Never a problem. I don't know what problems you've had, but I suspect it has something to do with your not understanding the benefits you signed up and paid for.
    The devil whispered in my ear, "You cannot withstand the storm." I whispered back, "I am ​the storm."

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    Re: Insurer agrees to pay medical bills after Twitter showdown

    Quote Originally Posted by MaggieD View Post
    I believe every single state has (Your State) Department of Insurance whose responsibilities, among other things, are to make sure that policy promises are kept.
    And those departments do not have the resources required to ensure that. You do realize that they receive thousands of complaints/year, right?

    Quote Originally Posted by MaggieD View Post
    If it's in the policy, your state's regulatory body will see to it that you're paid. Their penalties are damned strict up to and including barring a company from doing business in their state, massive fines and massive class action lawsuits.
    Class action lawsuits? ?

    It's extremely rare for a State Attorney General to sue an insurer. For every 10,000 illegally denied claims, there's only going to be one such suit. And there's a good reason for that: the Attorney General doesn't have the resources to file suits for every one of those 10,000 denied claims (and they're also prohibited for filing any suit on the patient's behalf). Class action suits can only be filed by private attorneys and then only in cases where the violations are so numerous as to ensure big fees for the attorneys.

    And the insurers are well aware of the fines and consequences they must face if they illegally deny a claim. That's why those companies have special departments to handle denial of claims expensive cases, i. e. in such a way as to make it difficult for the patient to seek external regulatory action on his/her behalf. Of course, it's possible the patient can get lucky and talk to an incompetent agent (a Hail Mary) who faxes a statement approving coverage for a procedure that's normally denied, but that doesn't happen too often.

    Quote Originally Posted by MaggieD View Post
    It's very important to keep the information brochures one receives when they sign up for a policy, read the paragraph headings within the policy that deal with how they pay claims...and read whole paragraphs when the paragraph heading applies to specific coverage.
    Any policy holder that actually took the time to do that (a herculean effort) and actually understood it from a legal standpoint would quickly realize that his/her policy is worthless given what the contract itself spells out.

    There's a whole slew of requirements as to what an insurer must cover by law (another 100 pages of reading) that isn't contained in the contract. And the people that work at the State's enforcement agency aren't readily aware of all of that law contains and esp. not how it pertains to individual cases. Only a lawyer who had the time to sort that out would know that, in other words, a private lawyer hired by the patient, something that costs big $$.

    Quote Originally Posted by MaggieD View Post
    If you have an HMO policy? All bets are off. That's because they're much cheaper than PPO policies and require a doctor's okay for testing. Other than that? I think it's fair to say that people can count on their health insurance policies.

    I personally have had, probably, $120,000 in medical bills paid by my insurer. Never a question. Never a problem. I don't know what problems you've had, but I suspect it has something to do with your not understanding the benefits you signed up and paid for.
    I don't believe you had $120,000 worth of medical bills covered by your insurer without a fight, threat of some kind. Did you use the incompetent agent faxing trick?

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    Re: Insurer agrees to pay medical bills after Twitter showdown

    Quote Originally Posted by solletica View Post
    I don't believe you had $120,000 worth of medical bills covered by your insurer without a fight, threat of some kind.
    I understand your not believing what you read on the internet; but it's nonetheless true.
    The devil whispered in my ear, "You cannot withstand the storm." I whispered back, "I am ​the storm."

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    Re: Insurer agrees to pay medical bills after Twitter showdown

    Quote Originally Posted by MaggieD View Post
    I understand your not believing what you read on the internet; but it's nonetheless true.
    It's not the Internet where I get this info. My explanation of insurance policy stems solely from logic resting on the assumption that any organization will always maximize profit for itself.

    It's like playing chess against a computer; one shouldn't make a move under the assumption his/her opponent is going to play poorly or not going to see a line of attack. One should make his/her move assuming the machine will always make optimal moves given the resources of its computing power and algorithms and the rules of the game.

    Health insurance companies, like any other company, are, for all practical purposes, like those chess computers--a machine that will maximize profits given its resources (insurers, FYI, use computers to decide on claims) and the rules of the game, i. e. the laws in place and the amount/extent of enforcement of those laws.

    And a claim filed by the patient is simply the patient making a move against that machine.

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    Re: Insurer agrees to pay medical bills after Twitter showdown

    Quote Originally Posted by solletica View Post
    It's not the Internet where I get this info. My explanation of insurance policy stems solely from logic resting on the assumption that any organization will always maximize profit for itself.

    It's like playing chess against a computer; one shouldn't make a move under the assumption his/her opponent is going to play poorly or not going to see a line of attack. One should make his/her move assuming the machine will always make optimal moves given the resources of its computing power and algorithms and the rules of the game.

    Health insurance companies, like any other company, are, for all practical purposes, like those chess computers--a machine that will maximize profits given its resources (insurers, FYI, use computers to decide on claims) and the rules of the game, i. e. the laws in place and the amount/extent of enforcement of those laws.

    And a claim filed by the patient is simply the patient making a move against that machine.
    You misunderstood my post. You stated that you didn't believe I'd had that amount of medical bills paid. That's what my post meant. Without concrete examples, I don't have much else to say. Good luck to you, Solletica. Health insurance is too expensive to not get what we pay for.
    The devil whispered in my ear, "You cannot withstand the storm." I whispered back, "I am ​the storm."

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