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View Diary: According to my home insurance plan (43 comments)

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  •  Health insurance does seem to run by its own (13+ / 0-)

    Set of rules, doesn't it?

    My husband submitted a claim for something he paid out of pocket. They denied it. He called and asked why. the woman instantly replied (it was obvious she hadnt looked anything up) "you didn't get that item pre-approved." He said, "I'm looking at pre-approval #xxxx, dated October 10, 2012, that was postmarked on October 11,2012. I'm holding it right now. Would you like me to email or fax it you?"

    (I would have been snotty and offered to drop it off. But mr grover is more gracious than I.)

    All of a sudden, finally, he heard her actually clicking on her computer: "oooooooh! Here it is! I'll see to it that this payment gets release at once."

    "Released." Not "issued."  

    I think they're automatically denying out-of-pocket claim checks. If the patient accepts the denial, swell. If challenged, the payment is already queued up. But they've had money sitting in their account an extra two months, earning interest.

    We'll see how quickly the check arrives...

    © grover


    So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

    by grover on Wed Dec 26, 2012 at 12:32:08 AM PST

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    •  It really does. (10+ / 0-)

      I have heard, but have no proof, that 3 denials are the norm before paying a claim in many large categories of health costs. I was fortunate to have a hospital billing person who walked me through what was really going on in the nonsensical claim & appeal process, but it was a lot of back & forth, starting with someone in India and not ending for more than a year after the claim opened. And that was a straightforward case, not a fight over experimental treatments or the like.

      Single payer won't solve everything, but it sure would help.

      •  Insurance is a racket run by middlemen. (6+ / 0-)

        It is legalized extortion, organized for the sole purpose of funneling money back into the banks, which condition property loans on keeping insurance policies up to date. One of the main features of keeping money artificially scarce is that it enables the financial folk to extort more for themselves.
        "Because you don't have much money, you have to pay us more."
        Our currency has been turned into a coercive tool.  Doing it legally attests to the fact that the law is coercive, as well. This is not new. Slavery was legal.

        We organize governments to deliver services and prevent abuse.

        by hannah on Wed Dec 26, 2012 at 02:27:58 AM PST

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        •  I've read your comments on this topic before. (1+ / 0-)
          Recommended by:
          grover

          I find their assertions do not generally accord with reality as I perceive it, though I often share the sentiment that seems to underlie them. Thanks for your comment, though. I know there are many who agree with you. They can, of course, choose not to be insured in most aspects of their lives, depending on their willingness to expose themselves to either risk of loss or risk of sanctions of various kinds -- legal sanctions in the case of auto liability, inability to obtain most mortgages in the case of homeowners, etc. Only Social Security and Medicare Part A premiums are coercively withheld from most workers, I believe.

          Societies began insurance arrangements to spread risk centuries before U.S. society existed. Despite the severe dysfunctions of certain aspects of our current insurance system -- primarily health, secondarily P&C for natural disasters -- the alternative is survival of the wealthiest. I think we're too far down that road as it is. YMMV.

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