Posts Tagged insurance

A License to Steal


LICENSE TO STEAL007 has a license to kill.  Insurance companies have a license to steal.  Here’s a typical example.

My mother suffers from back pain mostly due to her advanced age.  Her doctor prescribed lidocaine patches for the pain.  The patches are expensive, almost five hundred dollars per box.  My mother’s Blue Cross Blue Shield supplemental insurance declined to cover the patches.  Why?  According to BCBS, the FDA says the proper diagnosis for prescribing this patch is diabetes.  What?  Did BCBS make that up?  Sounds like it.

What’s the real reason for squirming out the responsibility to cover the patch?  Answer: it’s too damn expensive.  So let’s find a reason not to cover it.

According to AARP, 200 million insurance claims are rejected every year.  Insurance companies try to spread their risk and keep as much money in their organization for as long as possible as they “adjudicate a claim.”  They use auditing software to sift through millions of submitted claims.  These programs are often referred to as “denial engines” because their intent is to lower the amount of claims paid out.

Can we chalk this thievery up to rising medical costs?  No.  Insurance companies pay only a fraction of what doctors and hospitals charge.  I can hear the insurance company executives laughing in their Dayton, Ohio offices (which are located a long way from my little Starbucks table in Aventura, Florida.)

We need insurance reform badly.  I’m not talking about Obamacare. To facilitate their criminal activities, insurance companies hire supermen lobbyists with some of the money they should be paying out in claims.  They buy yachts, homes, Bentleys, commercial real estate, investment securities and commodities with the rest of their profits. They win. We lose.

It’s time for the public to start suing insurance companies en masse. My daughter is preparing to become a prosecutor. When she reaches the Federal level, watch out Aetna, Blue Cross, and all you other bums!

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David and the Insurance Goliath


You would think a company like Blue Cross and Blue Shield of Florida has its act together. Think again. Dealing with this company’s bureaucratic minions is a nightmare and a slapstick comedy rolled into one.

My eighty-six year old mother needed to convert her supplemental health insurance to another carrier. Since Medicare provides her primary coverage, I thought switching the supplemental would be no big deal. Just to make sure we got it right, I enlisted the help of an insurance agent referred to us by Blue Cross.

The fun began when my mother received a letter from Blue Cross denying coverage due to her application arriving outside of the annual enrollment period. The agent explained without apology that she was apparently confused about the application period. Three subsequent calls to this agent netted zero results. I was on my own in trying to resolve the problem — David vesus Goliath.

I called the 800 number listed in the rejection letter. The Blue Cross telephone representative promptly told me they could not help me. I had to call the Jacksonville office. “Where, by chance, am I calling?” I inquired. “The Sales Department,” the rep replied. “Aren’t you in Jacksonville?” I wanted to know. “No. You’ll have to call them tomorrow. They’re closed for the day now.” The telephone rep gave me the local number for the Jacksonville office. I had to ask for the toll-free number.I called the Jacksonville office the following morning. The experience turned into a multi-call ordeal for a number of reasons. Each time I called, the operator routed me to the wrong department. After copious delays, I finally reached someone who could help me. Each telephone rep gave me a different answer before putting me on hold for what seemed like forever.

I kept hanging up and calling again in the hopes of finding someone who actually knew what they were doing.The first telephone rep told me Blue Cross rejected the application because my mother’s supplemental insurance policy had lapsed. I told the rep, a nice woman by the name of Yvonne, that my mother’s policy was still very much alive and kicking. Yvonne then told me all we needed was the current policy number to resolve the matter. Great, I thought. I’ll just call my mother, get the policy number, and call sweet Yvonne back. Finally, we were getting somewhere.

Ten minutes later, I called Yvonne’s extension. “The line is busy,” the operator informed me. “Would you like to speak to someone else?” “No,” I replied. “Yvonne understands my situation.” The operator told me I had reached a call center where the reps take calls back to back. In other words, my chances of reaching Yvonne again were on a par with winning the Florida Lottery.

I was not going to ask if the call center existed within the confines of the Jacksonville office. I did not want to find out that the telephone reps who held my mother’s health insurance future in their hands were quasi-employees, or worse, independent contractors who cared exclusively about their hourly wage.I spoke to the next person, and the next one, until I reached David, my namesake, who seemed to fathom the arcane rules and closely guarded secrets governing the Blue Cross insurance application process.

David convinced me that we had to resubmit the application for insurance during the official enrollment period. I then discovered during the ensuing conversation that the application mailed with the rejection letter was misprinted. David promised to mail a corrected application form.I next asked David when Blue Cross intended to refund the first month’s payment mailed with the original application. David advised me to speak to my agent. I reminded David that I was speaking to him due to my agent’s total and complete incompetence, not to mention her unrepentant attitude.

After more haggling, David agreed to look into the refund. Five minutes passed during which I listened to irritating music interspersed with promotional messages aimed at motivating me to use more impersonal and less costly means of contacting Blue Cross to resolve my problems. I was about to hang up when David came back to advise me the refund would be mailed within two weeks. I asked him to fax a copy of the new application to me. He eagerly promised to do so. The fax never arrived.

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