Re: Insurance/Reply to

[Guest guest]

In a message dated 9/8/2004 8:21:05 PM Eastern Daylight Time,

formerbean@... writes:

I could find myself doing a lot less complaining if the darn insurance

company wouldn't lie to everyone who talks to them

Hi Christie,

Doesn't your hubby get a written copy of what is covered by your insurance?

Each year in Sept when the company where my hubby works reviews the insurance

for the coming year, he is given a copy of the different plans that are being

offered. Once he decides which plan he wants, he gets a written copy of the

plan showing exactly how much the insurance company will pay for services,

meds, etc and exactly how much we will pay, deductible, co-pay, etc.

hugs

Eunice

[Guest guest]

I fought for just shy of 2 years to have insurance company pay $1000

and change bill for procedure I had done outpatient. They kept

changing their story; not covered, you were not outpatient, lost

paperwork, you get the drift. I and the VP of company I worked for

worked together after I worked about 1 year alone. They paid

finally. I learned never pay, never forget about it, NEVER figure

insurance people are right. Do they automatically reject claims

because lots of people just give up or believe them.

Andy

-- In diabetes , ERWachter@A... wrote:

> In a message dated 9/8/2004 8:21:05 PM Eastern Daylight Time,

> formerbean@y... writes:

> I could find myself doing a lot less complaining if the darn

insurance

> company wouldn't lie to everyone who talks to them

>

> Hi Christie,

> Doesn't your hubby get a written copy of what is covered by your

insurance?

> Each year in Sept when the company where my hubby works reviews

the insurance

> for the coming year, he is given a copy of the different plans

that are being

> offered. Once he decides which plan he wants, he gets a written

copy of the

> plan showing exactly how much the insurance company will pay for

services,

> meds, etc and exactly how much we will pay, deductible, co-pay,

etc.

>

> hugs

> Eunice

>

>

>

[Guest guest]

> (snip)

> I empathize with the small business owners in the U.S. who are

trying to afford the cost of health insurance for employees, but I

also think the entire healthcare industry needs an overhaul in a big

way. I should be grateful just to have insurance and I am, but to be

told one thing and then find out the hard way that I have been lied

to is not my idea of great customer service.

> (snip)

Christie:

I agree with Eunice, you should be able to get a written " plan

summary " from either your husband's employer or the insurance

carrier. Put your request for a copy in writing, to the employer with

a copy to the insurer. In that letter ask that they answer you in

writing.

I guess I am fortunate (un-fortunate?) to see this issue from

both sides. I am a T2 diabetic, and also have a heart arrhythmia that

has hospitalized me twice over the last 15 months. I currently am on

4 prescriptions. As an employee, my insurance is a PPO which also

provides prescription coverage ($20 copay). So I recognize the

benefit of insurance coverage; and also the sometime hassle of

dealing with the insurance and medical provider billing systems.

But as an employer --- I find the cost of providing health

insurance to be my number one problem (and the yearly survey of the

membership of the nations largest organzation of small business

owners continually ranks it first). The policy I provide my employees

is a good PPO plan with Rx coverage. But the cost for " employee and

spouse " coverage is $12,150 per year, the cost for Rx coverage is

$4,263 per year ---for a total of over $16,000 per " employee and

spouse " per year. It is considerably higher for " employee and family "

coverage. I have shopped for other insurance companies, juggled with

deductibles, juggled with co-pays --- but the cost just increases by

10% to 20% each year.

When I have to add $16,000 on top of the wages/salary of ANY

prospective employee --- it makes it very difficult to make the

decision hire anyone! That is why the illegal(?) kickback scheme

offered by your mail order pharmacy got my attention -- and I would

want my insurance company to decline to participate in that scheme

too!

I agree that the insurance/medical system is a mess, but the

insurance agreement is a legal contract. The insurance company, the

medical community, and the employee must live by the terms to which

they agree. I hope that you are able to obtain a copy of the

coverage, and I wish you and your family good luck and good health.

, Charlotte NC

[Guest guest]

Try

http://www.dol.gov/ebsa/publications/how_to_obtain_docs.html

This may be of some help to you. I thought law said you had the

right to be informed, could be wrong. Sorry but I think your plan

is on shady side also. Your auto insurance co. will not go with

most expensive repair shop...same thing. I have no insurance

anymore and being on 8 different meds it isn't a cakewalk for me

either. I was quided by dr. to some programs that give discounts ot

free meds...not talking about discount cards but plans put out by

med companies But cutting corners on the the system is not the

answer, change the system. Insurance companys can hollar all they

want but look at their profit statements. I have no love of

insurance cos. and I could not care less if they are treated fair or

not but with this system they call all the shots. Yhat's my nickels

worth and worth a little less than that.

> > (snip)

> > I empathize with the small business owners in the U.S. who are

> trying to afford the cost of health insurance for employees, but I

> also think the entire healthcare industry needs an overhaul in a

big

> way. I should be grateful just to have insurance and I am, but to

be

> told one thing and then find out the hard way that I have been

lied

> to is not my idea of great customer service.

> > (snip)

>

> Christie:

> I agree with Eunice, you should be able to get a

written " plan

> summary " from either your husband's employer or the insurance

> carrier. Put your request for a copy in writing, to the employer

with

> a copy to the insurer. In that letter ask that they answer you in

> writing.

> I guess I am fortunate (un-fortunate?) to see this issue from

> both sides. I am a T2 diabetic, and also have a heart arrhythmia

that

> has hospitalized me twice over the last 15 months. I currently am

on

> 4 prescriptions. As an employee, my insurance is a PPO which also

> provides prescription coverage ($20 copay). So I recognize the

> benefit of insurance coverage; and also the sometime hassle of

> dealing with the insurance and medical provider billing systems.

> But as an employer --- I find the cost of providing health

> insurance to be my number one problem (and the yearly survey of

the

> membership of the nations largest organzation of small business

> owners continually ranks it first). The policy I provide my

employees

> is a good PPO plan with Rx coverage. But the cost for " employee

and

> spouse " coverage is $12,150 per year, the cost for Rx coverage is

> $4,263 per year ---for a total of over $16,000 per " employee and

> spouse " per year. It is considerably higher for " employee and

family "

> coverage. I have shopped for other insurance companies, juggled

with

> deductibles, juggled with co-pays --- but the cost just increases

by

> 10% to 20% each year.

> When I have to add $16,000 on top of the wages/salary of ANY

> prospective employee --- it makes it very difficult to make the

> decision hire anyone! That is why the illegal(?) kickback scheme

> offered by your mail order pharmacy got my attention -- and I

would

> want my insurance company to decline to participate in that scheme

> too!

> I agree that the insurance/medical system is a mess, but the

> insurance agreement is a legal contract. The insurance company,

the

> medical community, and the employee must live by the terms to

which

> they agree. I hope that you are able to obtain a copy of the

> coverage, and I wish you and your family good luck and good health.

> , Charlotte NC