Insurance Companies

"You can't put a value on life, but my wife's life insurance company made a pretty fair offer."

—Author Unknown

I had a really crappy experience with an online health insurance company last week so I thought I'd get my frustrations out in this week's column.

My favorite activity in the world is to get on the phone with unknown folks and try to straighten out insurance claims. My second favorite thing in the world is beating myself in the head with a hammer because it feels so good when the pain stops.

My health insurance works pretty good most times but when it goes off the rail it really goes off the rail. I wish I could just walk down the road and talk with one of our local insurance agents and get things straightened out. Instead, it's using the phone trying to get to a real person as a substitute for computer recordings. Also, each time you call you get a different person.

One time my wife went for her annual mammogram. Does it every year and my insurance policy allows for it. Until one time it didn't. They denied the claim. The hospital resubmitted it a few times and it kept coming back rejected. So I called the insurance company and asked if my wife was entitled to an annual mammogram. They said yes. I asked if it had been over a year since her last one. They said yes. I then asked why they kept denying the claim.

I kid you not, this was the answer: "Our computer system for some reason is denying all mammogram claims due to a glitch."

I asked when it would be fixed. They didn't know and suggested I file a formal complaint to the state insurance commissioner and maybe it would shake their insurance company to fix the mistake.

What???

You want me to get the government involved so your company will fix an internal computer problem. I did write letters to them and my congressman and the problem got fixed. But it took over 9 months.

My first thought was how many people would have just paid the bill and the insurance company would have gotten off scot free? Probably a lot.

A different insurance company from my former employer did a different variation of the same thing. Every time I sent in a claim they would reject it. I would then call them and they would say "You're right. We made a mistake." Then the claim would be processed.

The first time that happened didn't bother me. I thought people do make mistakes. But it kept happening over and over again. We had five kids, four were girls, and we went through a lot of medical claims.

I was talking with a buddy at work and in frustration told him about the problem and said "What is wrong with these people?" My buddy looked at me as if I were naïve and said "Nothing. They're just hoping you don't call up in the first place and you just assume you owe the bill. Most folks don't know about insurance and figure if they say you owe then you owe."

The small bills are annoying but there are large bills that can be frightening and lead to a lot of sleepless nights. Here's one.

I have had a chronic problem with nasal polyps for over 30 years. They aren't cancerous but have to be removed to prevent brain damage or blindness. I have had ten operations removing the polyps and most went well. Again, until it didn't, which was about 25 years ago.

Long story short, the company rejected the whole claim and it was about $60,000. I was sweating bullets. Fortunately, my father cut out an article in Money magazine on filing appeals to denials of claims. You can do that.

It was a three appeal process and the article said the first two appeals almost always favored the company but the third appeal was the one where you might get an approval.

It was a lot of paperwork including second doctor opinions. I had about 20 pages of documentation and sure enough the first two appeals were rejected with the third appeal being accepted. I don't know how it works today but it was nerve racking to say the least until I got the approval.

Thank you daddy for that article!!!

Again, how many people would know enough to fight this? I wouldn't have if my dad didn't give me that magazine article detailing out appeals.

Recently Cindy had an operation on her arm. This was in September. I didn't find out until January that they denied all claims amounting to about $30,000. Don't worry. I ended up with paperwork to complete that the doctor's office and surgery center had no idea needed to be done. Hopefully, in a month or so this will be resolved but I won't rest well until it is. Medical bills are so incredibly high

How common is this?

A friend of mine recently retired after a lifetime of working at one of the largest insurance companies in the U.S. and the world. He was a big shot there and I met him when he was still in college. We keep in touch a couple of times a year on the phone. He said he recently had a glitch with his insurance and got turned over to collections while he was trying to work it out. Made him mad.

Even the mighty have their troubles.

Insurance.

Can't live with it. Can't live without it.