Hierarchy of Insurance?

[James]

You have a 5, 6 8 million dollar policy? You won't get within missile distance of those numbers before the insurance company stopped authorizing treatment and procedures. "5 million" is an adversiting gimmick.

Isn't that why we have lawyers and the DOI? You're telling me that Assurant won't pay the full 8 million if you buy that rider? That's news to me. How are they going to not pay... how will they get away with it?

If so, maybe what we need to sell in conjunction with insurance is a pre-paid legal policy with a law firm that targets insurance companies? That might be a winning combo of products.

Al

Because if you are in a such a sickness or injury there are as many different views of treatments or no treatments as there are Dr's! Guess what the Dr's will decide on that are hired by the Insurance Carriers have to say? You guess it, the cheapest way out for the H/C! Plus they'll want more and more clarification and will start denials on reguested treatments by the treating physician if there is a cheaper alternative and otherwise make your life a PITA. Plus there isn't much DOI can do when in these type of situations, and for every attorney you may hire I assure you they have 10 better paid attorneys working for them.

 

[Guest]

and for every attorney you may hire I assure you they have 10 better paid attorneys working for them.

So you are saying you and I are selling snake-oil? A scam? That our carriers (Blues, Assurant, Aetna) are not going to stand behind their products? That's pretty upsetting news.

Al

 

[Crabcake Johnny]

Health insurance will pay fine for regular and even extreme events. Have a heart attack, stroke, $50,00 - $200,000 even $500,000 bills will be paid. But get into the millions and you'll get "case managed" to death. No health insurance policy is designed to handle cataclysmic events like Christopher Reeve. And in fact Reeve had full medical insurance and had to count on friends and fundraisers to pay his medical bills. Nothing pays for in-home 24 hour care. Almost all health insurance plans cap skilled nursing at 30 days. No one's gonna get 3 years of outpatient physical therapy on any plan.

Regarding the "8 million" in coverage - no single procedure costs 8 million. Even seperating conjoined twins is just over 1 million - no where close to 8.

Imagine a horrible car accident where you're in a coma for months. Then you come back but have to basically re-lean everything; speech, walking etc...As soon as you're well enough to leave you're screwed. You need at-home nursing and years of therapy and no policy will pay for.

No - you're not selling snake oil. For large events you're saving people from BK. But if one of your clients ever became a parapalegic it's game set and match.

 

[Guest]

Regarding the "8 million" in coverage - no single procedure costs 8 million.

It's an X million LIFETIME cap, not a procedure cap. So you tell me that Blue Cross of CA will do all they can to weasel out of the cap they set, should an insurred suffer a horrible 'event'? I don't know about the regulators in MD, but I don't think BC would get away with it here in CA.

Besides, to BC, 4 or 5 mill is lunch money. It's just not a sum worthwhile to risk in bringing down the wrath of the CA DOI and the ton of consumer advocates, and the press, and the class-action law firms.

You (an insurance company) can't get away with crap like this in CA. This is not New Jersey :-)

Al

 

[Crabcake Johnny]

Right now Blue Cross in CA is being sued by everyone for rescinding coverage after people file claims:

http://law.freeadvice.com/insurance_law/insurers_bad_faith/blue-cross-retroactive-review.htm

http://www.lawyersandsettlements.com/case/wellpoint_policyholder_classaction

http://www.rightnation.us/forums/lofiversion/index.php/t115582.html

I'm not too sure about Blue Cross in CA. The Blue's in MD don't seem to pull this crap. I certainly wouldn't recommend them to anyone.

 

[Guest]

Right now Blue Cross in CA is being sued by everyone for rescinding coverage after people file claims:.

Well, that's sort of my point. They ARE being sued... and dollars to doughnuts they (BC) will lose. I'm not going to defend BC or the industry, but I will say that if you are an insurance company in CA you ought to be smarter than to do what BC has allegedly done because as the links you posted point it, you will be sued and you will not have a sympathetic friend in the office of the DOI.

And if you read the notices, BC has been forced to settle most of these. I don't know about MD, but CA is a very insurance-consumer friendly state. I've met both the previous DOI and the newly elected one... and I would not want to mess with either. (Previous is now Lt. Gov.) CA government has a a few badly run control agencies and bureaus, sometimes in the hip-pocket of the entity they are regulating, but the DOI is not one of them in my opinion.

It's sort of how the old "Lizzie Borden" Kingston Trio song went:

You can't chop your father up in Massachusetts
And then go out for a walk
No you can't chop you father up in Massachusetts
Massachusetts is a long way from New York.


Al

 

[James]

WellPoint, the largest health benefits company in the US, is alleged to have systematically and illegally released policyholders with costly medical care.

The suit claims that Blue Cross looks for mistakes or omissions in approved health insurance applicants to cancel policies and avoid paying expensive medical claims. The suit also alleges the Blue Cross application is designed to be confusing with the intent to trap applicants into misstatements and omissions that could cancel their policies.

One plaintiff's Blue Cross coverage was cancelled when she contracted breast cancer – she "had failed to disclose on her original application that she has been exposed to hepatitis B." She had been exposed as a child and didn't think there was any problem with the exposure.

Another plaintiff's Blue Cross policy was cancelled after she needed gynecological surgery – "she had not disclosed to Blue Cross that she had been treated for severe, migrainelike headaches in 2000." The plaintiff claims she did not check off this item because it was included with other symptoms such as seizures and epilepsy, which she didn't have.

Now I'm not sure, didn't think exposure to Hepatitis B was relevant? She didn't claim she didn't remember but didn't think it was relevant? Hepatitis B? Not relevant? Kind of like your spouse not telling you she/he had a STD's since you'll were married but didn't think it was "Relevant" enough to inform you before hand.

The other one seems border line, severe headaches. Depending on how long they lasted, if for nearly a year or more than I would agree, that would seem worthy to note.

So the real question is the practice of post underwriting, now this isn't new and I don't see much any State (including CA) can do about it since it falls under Failure of Ommission or Fraud like illegalities on the part of the client. Yet I suppose there should be limits on how far back they should be allowed to view, well you know they now want DNA testing! What a hoot.

 

[Crabcake Johnny]

One good thing to note is not to give the insurance company the opportunity. Make sure everything's noted on the app and explain how claims review works. I tell every client about claims review before filling out an application.

Some clients will indeed forget some info and it's your job to jog their memory.

 

[arnguy]

I believe that most state DOI would frown upon "post claim underwriting" and take punitive action. Early in my career I wrote for some health insurance companied and/or agencies that sold cheap health insurance policies (I was naive). In one particular case, the CEO got a 7 year federal sentence for fraud and had all hisproperty confiscated.

 

[James]

I believe that most state DOI would frown upon "post claim underwriting" and take punitive action. Early in my career I wrote for some health insurance companied and/or agencies that sold cheap health insurance policies (I was naive). In one particular case, the CEO got a 7 year federal sentence for fraud and had all hisproperty confiscated.

I do believe they all do it, they have to protect themselves. Plus the financial health of the carrier is an absolute necessity something I'm sure most DOI's understand, now California may be a different story.