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.
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