Hands Off My Health Care..and Yours Too

You may have noticed that insurance companies aren’t getting any love lately.  And there are indeed some horror stories out there, mostly concerning health insurance, but let’s not forget the world of auto and homeowner’s insurance policies.  They too are mostly unloved, but no one is even paying attention to them now.  That is especially cruel.  Not only to be unloved, but unmentioned.  Like the saying goes, there is no such thing as bad publicity. 

Naturally, Fakename has a few opinions about the subject that might be construed as political in nature, but she will keep them to herself at this time.  She personally was the recipient of a massive payout by her health insurance company back in 2006, and therefore has little to complain about.  Not that that would necessarily stop her.  The massive payout, however, did not come without occasional glitches.  Warning:  the story to follow will not be particularly graphic, but it will mention body parts. 

So back in 2006, the day came when I had to have two biopsies on the same day.  When the EOB (Explanation of Benefits) came back from the insurance company, they had paid one and denied the other.  On the EOB there is a number to call if you have questions or wish to dispute the decision, which, by the way, you have 30 days to do.  Try having a serious illness and figuring out what the EOB is saying, much less keeping track of the number of days since you received it. 

Somehow I got two brain cells to rub together and called “Customer Service”, two words which have a hard time standing next to each other in the same sentence as “Insurance Company”.  The Customer Harassment Representative informed me that the reason one of the claims was denied was that it was physically impossible for me to have had two separate types of biopsy on the same day. 

Hello, I said.  I have two breasts.  One biopsy was on one breast and one was on the other.  The CHR allowed as how that was not her problem, and I would have to take it up with the doctor’s office.  So I did, and they said, “Oh, we must have coded it incorrectly”.  Ah yes.  The Codes.  Be aware that if you have a cold, you don’t really have a cold.  You have a 460.0.  Apparently the doctor’s office had neglected to include the part of the code which specified “left” or “right”.  Be aware that any body part you have, or affliction thereof, has its own code.  They resubmitted the claim, and it was paid.  Happy ending. 

Then there was the time when my doctor wanted me to go to a specialist, and made an appointment for me with a local and very esteemed one.  He, however, was not “in the plan”.  Now the rules say that if there is no one in the plan within 50 miles, the “out of plan” doctor has to be treated as if he or she is “in the plan” (translation:  the insurance company has to pay a higher percentage.)  The insurance company’s website claimed there was such a doctor within 50 miles, in a town I knew to be further away than 50 miles.  In fact, it turned out it was 62 miles.  (I was not about to go to a specialist in some one-stoplight town in Georgia if I could help it.)  We all had a huge fight.  Me, my employer, and the insurance company.  It all had to do with Mapquest, which is where the insurance company got its measurements.  50 miles was from the state line.  I argued that it was not 50 miles from me, it was (according to Mapquest!) 62 miles–minimum.  Whether you started from my personal address or the city limits of Tallahassee.  I won.  But what a lot of wasted energy.

In closing, there is the auto insurance issue.  Like a Good Neighbor, State Farm cancelled both my auto and homeowner’s insurance policies after 13 years.  Then I bought a new car, which is a neat trick when you don’t have auto insurance. I got a new company and paid for six months in advance; next thing I knew, they were sending me bills online.  I deleted them.  I did that for two months, then week before last, I received a bill for $44.20 in the actual mail. 

So I called the agent.  It turns out that buried in those emails (the amount of the bill being Zero) was a demand to respond in order to retain my ” paperless discount”.   This is a scam of major proportions, in my opinion.  They agreed to let me pay half–$22.10.  In return, I get to keep my auto insurance.  What a deal.  In this case, as they say, it isn’t the money–it’s the principle. 

So in closing, I lied.  I do have a political comment.  Have any of those people chanting “Hands Off My Health Care” ever had to deal with a real-life insurance company?  The system works just fine as long as you aren’t sick.  When you are, good luck.

19 responses to “Hands Off My Health Care..and Yours Too

  1. masteroftheuniverse

    I let my doctors bill the insurance company as I agree with you what a hassle it is and don’t wish to deal with insurance crap. I had State Farm cancel me, as I live at the beach and had to go to Citizens……which really sucks.

  2. My doctors bill the insurance company too. It’s just that you, unfortunately, still have to be involved. Had I not disputed the biopsy issue, I would have been on the hook for maybe $2,000 I should not have been. In the end, that would have just added to the mountain of unpaid medical bills I have. I just try to keep it to a minimum.
    As for auto and homeowner’s…we have special challenges here in Florida. Citizen’s. So far I have avoided them…but might not be long before I’m forced. It’s not a good deal, but there are worse ones out there. Such as no insurance at all. At least I don’t live on the beach. I only live in the middle of massive oak and pine trees. No danger there.

  3. To continue the non-political comments 🙂 Insurance is a business. Since I also operate in the business world, I understand the ABC’s of it. Maximize profits, minimize expenses.
    Expenses=payouts. Try to minimize them. Death panels, anyone?

  4. About those oak and pine trees – you will NEVER find me in the al fresco part of (oh, drat! what is the name of that place – Chez something) after watching that branch come down on the tables. Not that the porch roof would have protected us all that much!

  5. Pierre 🙂 Chez Pierre.

  6. An increasing number of “elite” doctors in NYC no longer deal with insurance or even accept medicare. They demand payment upon service, and then it’s your problem to get reimbursed by the insurance company. Obviously, only doctors with incredible reputations and a queue of patients can take this approach, but take this approach they do — and it can require very substantial payments upfront. Most of these doctors also charge fees substantially above the insurance/medicare reimbursement rate … it’s up to the patient to decide whether the extra cost is “worth” it.

    (I expect that this trend will become an epidemic had a single payor system gone through. When I lived in England, and similar two-tier system existed for certain specialists. That was the dirty little secret of national health insurance … and it shouldn’t really surprise anyone….)

  7. Fakename is not surprised in the least, since it is not only NYC where this happens. In my medical travels, I’ve seen many signs posted that say We Do Not Accept Medicare. I believe that has to do with the substandard rates Medicare pays. So there is a legitimate fear out there that if all health care is reduced to Medicare rates and standards, you won’t be able to find a doctor. On the other hand, the advantage of a single-payer system may be that it reduces doctors to a more level playing field, and more of them are willing to accept something as opposed to nothing. Not to mention that single-payer (which is a dead duck) spreads the risk sufficiently to reduce the cost of insurance. It will never cure the two-tier system of which you speak, and shouldn’t be counted on to do that. Nor would I even want it to. The real philosophical question behind it all is whether or not you believe insurance of any kind is a good idea.
    Because if you get right down to it, the money you paid in premiums helped save my life. (And I appreciate it greatly!) I used up, by far, more than I ever paid into the system. So if you want to be a complete individualist, you should opt out of the system. (I am not referring to you personally here, Rocky, it’s a general opinion, which should technically be avoided.) Get a Health Savings Account. Then when that money runs out…kindly die gracefully.

  8. masteroftheuniverse

    In a couple of weeks I have to go to Mt Sinai for a treatment that’s very off the wall but 100% effective. I have to pay up front and have them do their magic, then get my insurance to pay whatever. It’s an outpatient procedure, but I am a bit leery about leaving a hospital with two drilled holes in my skull. still, a fr=ew thousand hacve done it before me, and I will just have the procedure and chill.

  9. Masteroftheuniverse:
    You are not alone! Moses went up to Mt Sinai and had proverbial holes drilled with no insurance and 5,000+ years later the treatment is still working. 😉

  10. eeeeek! Jeff. I thought I had become immune to being probed with medieval instruments of torture, but this one gets me! I reccommend pre-test Valium!

  11. Fortunately, I’m with one of the top HMO’s in the country – Capital Health. Never had a problem with them in 25+ years.

    As for insurance, when State farm announced it was withdrawing from Florida, I decided to leave them first.

    After researching at A.M. Best, I went with Cotton States, which is backed by another very deep pockets firm. The deal is they (Cotton States) have a limit in new customers each month.

    But since I was bringing them everything -house and two cars – I was a t the top of the list. I’m paying within $10 of what I paid SF *and* I have a slightly better policy.

    I’d been with SF in Tall since 1981. They tried to keep me but I told them I didn’t like their attitude about leaving. They could stay and offer me a discount, but I wasn’t doing business with them.

    There’s more than price, and I walk that walk. They were jerks to a lot of folks after Katrina and I won’t do business with jerks. When and if CS shows me they are jerks, I’ll leave them too.

    Once I pay of the last $25,000 on the house, which is anytime I want to, I will drop hurricane coverage.

  12. Spencercourt: What does hurricane coverage cost that makes you inclined to self-insure? It seems like you can count on a CAT3-CAT4 storm every 30-50 years –so are they really charging more than 2% of replacement value for insurance? Or are you planning to ask Uncle Sam for a FEMA trailer when you’re 70 years old — having lost everything in the 100-year flood that happens every 50 years?

  13. Fakename has to laugh at the confrontational nature of these comments. Men 🙂
    First of all, there is no such thing as hurricane insurance. There is flood insurance. There is wind damage insurance. Flood insurance is always extra.

  14. fakename: I can only imagine the conversation in the Spencercourt household right now:

    Spencercourt’s Wife: “I just read fakename’s blog and she says that there’s no such thing as hurricane insurance.”
    Spencercourt: “Ummm”
    Spencercourt’s Wife: “You told me that we had to buy hurricane insurance every year.”
    Spencercourt: “Ummm”
    Spencercourt’s Wife: “You said that we never had any extra money lying around because of that doggone expensive hurricane insurance premium.”
    Spencercourt: “Ummmm”
    Spencercourt’s Wife: “I understand now. You’ve been keeping a bimbo in that apartment on the other side of town….and using the hurricane insurance story so you could buy her baubles … while I sit here … with hurricane insurance … that doesn’t exist.”
    Spencercourt: “Dear, please don’t be mad at me. Just think of the peaceful nights sleep that you had during Hurricane Katrina, and Hurricane Andrew … thinking that you were insured. While I “twisted and turned” knowing the truth … that we didn’t have hurricane insurance. Gulp.”

  15. Fakename is laughing in spite of herself, but would like to point out that it is Rocky who mentioned the non-existent hurricane insurance 🙂 “Hurricane” is not in the insurance company vocabulary. It was a huge deal after Katrina when folks all along the Gulf Coast had to prove their homes were destroyed by wind rather than water. Since, like I said, flood insurance is extra. Which is pretty smart. Normally, it isn’t the wind that gets you…First there is the wind, then there is the water. So what was it? (There we go with the chicken and the egg,)
    Also, having met her in person, I’d like to say that Mrs. Spencercourt is a remarkable woman. One hopes that Spencercourt himself gets that 🙂 And I think he does. They are a very sweet couple.

  16. fakename: actually it was spencercourt who used the term “hurricane coverage,” and the fact that he intended to cancel it — and i enquired what does hurricane coverage cost.

    in the interests of full disclosure, we don’t have flood insurance — since we live on the side of a very steep hill — yet, our basement is very occasionally flooded: once when the boiler blew out, and another time when there was a freak rain storm in the middle of the winter that caused a freak snow melt that. neither condition would have been covered by flood insurance.

    we also don’t have “wind insurance” — however, if the wind knocks over a tree and it hits the house, we are covered for that.

    when i looked at purchasing a beach house, i discovered that if you are in the wrong FEMA map zone, you are virtually uninsurable. there’s some insurance pool that will cover you for $250k, but it’s almost impossible to get coverage (for any reasonable amount of money) that will protect you against a serious storm (or beach erosion).

    kidding aside, i’m curious what coverage costs for wind/flood/etc in your neck of the woods?

  17. I don’t actually know the answer to those questions, Rocky. I don’t have flood insurance. I did when I lived in New Orleans. If I’m not mistaken, when you live in an A zone, you’re required to carry it–at least that’s what they told me 🙂 However, in an A zone the feds chip in and subsidize the cost, so I want to say it was about $200 a year. Don’t know about wind either. I guess I should take a peek at my policy.

  18. What I remember learning is that the bank won’t give you a mortgage in certain zones unless you have particular amounts of coverage — and the state/federal plans won’t provide enough coverage to satisfy the bank. The particular property that I examined on Cape Cod was at risk of not only flooding but also beach erosion. (It was possible that after a 100 year CAT4+ storm , the house, the beach, everything … might be gone … poof ….)

    It’s worth noting that quite a few houses along this beach were worth many millions (a couple were over $10million) … and you’ve got to have an awful lot of money to be willing to pay cash, and then self-insure against a catastrophic storm. (The bank said that Lloyds of London would always provide coverage, but the premiums could be more than 10% of the coverage amount …)

    The obvious conclusion was that we didn’t buy a house on the beach…for any amount of money.

  19. That’s funny…Lloyd’s of London was who my homeowner’s policy was with in NOLA. I was on high ground there…3 feet above sea level 🙂 And the house sat on a raised foundation that added 3 more feet.
    I had a friend with a house on Dauphin Island (off the coast of Mobile) and didn’t insure it. Then it was obliterated by a hurricane. But he said it was cheaper to rebuild than pay the insurance. Obviously it was a very modest house, nothing in the millions.
    I thought sure you might comment about the subsidies. It seems somewhat strange to me. Doesn’t that encourage people to live in flood-prone areas? As an aside, it always amuses me when people say we are nuts to live in Florida because of hurricanes. I then start my list of disasters…earthquakes, forest fires, prairie fires, tornadoes, record snows, locusts….etc.
    Tallahassee is about 25 miles from the Gulf as the crow flies, which is a bit of a cushion, but won’t help much if a CAT-5 comes straight at us. Kendall and Florida City were wiped out by Andrew, and they’re inland too.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s