Christian Health Ministries

[STIBROKER]

right, because the AG is going to reverse every single claim that gets denied. Tell that to the all the people on pissedconsumer.com that get claims denied.

Y'all are living in a fantasy land if you believe the government is going to protect you, and make everything right.

back up........

 

[rousemark]

right, because the AG is going to reverse every single claim that gets denied. Tell that to the all the people on pissedconsumer.com that get claims denied.

Y'all are living in a fantasy land if you believe the government is going to protect you, and make everything right.

The point is there are possible avenues of relief with insurance companies. What avenues are available with me I - share?

 

[DS4]

Any agent who has been in the business any significant amount of time and has a decent size block of business has seen this happen before by the insurance companies.

This May, I'll have 40 years of peddling health insurance under my belt. I also have a huge block of Group, Med supp, and, under age 65. I have NEVER seen a legitimate claim get denied, that eventually wasn't paid. What I have seen, is many of my carriers pay bogus claims.
And why would they pay bogus claims?? They tell me, "To avoid the bad press".

 

[rousemark]

This May, I'll have 40 years of peddling health insurance under my belt. I also have a huge block of Group, Med supp, and, under age 65. I have NEVER seen a legitimate claim get denied, that eventually wasn't paid. What I have seen, is many of my carriers pay bogus claims.
And why would they pay bogus claims?? They tell me, "To avoid the bad press".

As I have always said, " I have seen far more clients try to beat the companies than companies try to beat clients.....

 

[somarco]

This May, I'll have 40 years of peddling health insurance under my belt. I also have a huge block of Group, Med supp, and, under age 65. I have NEVER seen a legitimate claim get denied, that eventually wasn't paid. What I have seen, is many of my carriers pay bogus claims.
And why would they pay bogus claims?? They tell me, "To avoid the bad press".

We have a similar background although I am new to Medicare and may have more experience than you with U65 health insurance.

During that time I have seen more BOGUS claims paid than LEGITIMATE claims denied. I participate in a couple of consumer forums and quite often see complaints about denied claims. In virtually every case the policyholder did not understand their policy, usually because they never read it until after the claim was denied.

There are also repeated complaints about unpaid bills turned over to collections "even though I paid my copay". When asked if they compared the EOB to provider statements the answer is always "no".

Carriers will routinely pay BOGUS claims especially when there is public pressure. It is cheaper to pay a bogus claim than fight the claim in the court of public opinion.

One of my former employers paid out over $120k on a claim incurred AFTER the policy was non-renewed by the POLICYHOLDER.

Agents who complain about carriers denying claims are just as ignorant about insurance contracts as the folks who buy the policies.

LEGITIMATE claims are always paid. Over the last 43 years covering probably 50,000 individuals I have interceded on behalf of clients numerous times. In almost every situation the claim was legitimately denied. Client didn't like the outcome but once they understood why it was denied they accepted the outcome.

In a few cases where there was a billing or coding error the claim was paid.

Two weeks ago a long time client called because a $28k hospital claim had not been paid by Medicare or his Medigap carrier. He sent me the MSN's and EOB's.

Turns out the claim (incurred in July) had never been submitted to Medicare.

You will never see me say the carrier, or Medicare, is always right because mistakes do happen. But when a claim is denied there is almost always an explanation.

Too bad some agents don't understand the process. Maybe they need a different line of work.

 

[scagnt83]

I have NEVER seen a legitimate claim get denied, that eventually wasn't paid.

....
In virtually every case the policyholder did not understand their policy, usually because they never read it until after the claim was denied.

.....

Agents who complain about carriers denying claims are just as ignorant about insurance contracts as the folks who buy the policies.

LEGITIMATE claims are always paid. Over the last 43 years covering probably 50,000 individuals I have interceded on behalf of clients numerous times. In almost every situation the claim was legitimately denied. Client didn't like the outcome but once they understood why it was denied they accepted the outcome.

In a few cases where there was a billing or coding error the claim was paid.

......

But when a claim is denied there is almost always an explanation.

Too bad some agents don't understand the process. Maybe they need a different line of work.

This is spot on.

There is always a reason for denial that falls under the contract, and if its a legitimate claim, there is always a way to correct the issue.

Agents who accuse carriers of unfairly denying claims only make fools of themselves when doing so. And it shows how little they know about the product.

------

The business owner of one of my groups was recently irritated about a dental claim that was not paid yet. The owner was blaming the carrier for this.

It wasnt denied, they just requested some follow up info on the claim.

I checked into it; his dentist didnt fill out the claim forms correctly.

The client was pissed because "they didnt tell the dentist that" ... and of course he says "my dentist wouldnt just ignore them, he deals with this carrier all the time".

Well, turns out they did contact the dentist... twice. And that is why they were contacting the client directly about it. The dentist office dropped the ball, but all the blame was put on the carrier.

I told the client this and he completely understood and apologized. Once the carrier had the correct info the claim was paid like always.

 

[Louis Gallucci]

My dad is a pastor and his church just joined a program called Missio Benefits (www.missiobenefits.com). It is based on biblical values and leverages the unity of the Church to reduce cost. That said unlike healthcare sharing (with its host of potential contractual pitfalls) is an actual global/domestic group healthcare plan administered by Cigna. It is available in all 50 states but only for Christian employers (not individuals). Not sure if this helps but worth checking out!

 

[STIBROKER]

My dad is a pastor and his church just joined a program called Missio Benefits (www.missiobenefits.com).

Run away....hard...and fast......

 

[Louis Gallucci]

Why is that since it's not a sharing program? Youth for Christ (YFC) is a major US ministry and they love it to...

 

[WinoBlues]

Why is that since it's not a sharing program? Youth for Christ (YFC) is a major US ministry and they love it to...

What is your position there?