09 December 2024, 16:48
Michael RobinsonCorporate Lesson No. 1
Corporate Lesson No 1: If you are a health insurance CEO with a multi-million dollar annual income, and if you are receiving anonymous threats on your life, you should hire a Tier 1 security detail and never leave home without them.
No joke.
09 December 2024, 17:04
SaeedIf you are in charge of a health company, and refuse over 30% of claims, you should be on your toes!
09 December 2024, 21:27
MoremonteJust Shows That Anyone Can Become a Target If Needed.
09 December 2024, 22:15
df06And, when you are buying an insurance policy, familiarize yourself with what is covered, what is not covered, what are the limits and deductibles.
13 December 2024, 08:07
Norman ConquestExactly. I just posted one of my experiences on the Miscellaneous forum. I learned my lesson on that one (until the next one comes along), Now I carry full coverage on my vehicles, but I'll bet they find a way to get out of that too.
28 December 2024, 21:02
Grizzly Adams1quote:
Originally posted by df06:
And, when you are buying an insurance policy, familiarize yourself with what is covered, what is not covered, what are the limits and deductibles.
That is why policies should be in plain language, not legalese.
29 December 2024, 06:28
lavacaGrizzly,
I'm an insurance lawyer and represent insurance companies. Don't represent health insurers.
For all of you out there, my clients want to pay claims that they owe at a fair amount.
You wouldn't believe the fraudulent claims I see, usually pushed by plaintiffs' lawyers. They are the real problem for all of us. You pay more for everything you buy because of unscrupulous plaintiffs' lawyers. Let that sink in. And think about it if you are on a jury.
As for "plain language" in insurance policies, they had a push for that about 20 years back and it's not a good idea. Seems like it would be, but any ambiguity is construed against the insurance company and the classic language that has been used for 100 years or so has been interpreted by the courts so we (meaning the lawyers) all know what it means. As soon as you change it there is no authority interpreting it, I don't know what it means and the court doesn't know what it means. Bad idea.
18 January 2025, 23:09
crbutlerSorry, Lavaca
I'm on the other side of the health insurers.
They refuse a large part of billings, and strangely enough if you resubmit it without changing a thing a fair amount of the time a substantial portion gets approved the second time through.
If I want to prior authorize something or get a nonformulary request... that takes a lot of time and BS.
Now I will admit that there are more than a few patients that want nonformulary items for reasons that I find stupid (like I want the purple pill because purple is my color and the ads are saying its better even though they haven't tried any acid blocking med yet...)
And yes, United Health was always a big PITA for me.
Don't deal with them now much, thank god.
quote:
Originally posted by lavaca:
Grizzly,
I'm an insurance lawyer and represent insurance companies. Don't represent health insurers.
For all of you out there, my clients want to pay claims that they owe at a fair amount.
You wouldn't believe the fraudulent claims I see, usually pushed by plaintiffs' lawyers. They are the real problem for all of us. You pay more for everything you buy because of unscrupulous plaintiffs' lawyers. Let that sink in. And think about it if you are on a jury.
As for "plain language" in insurance policies, they had a push for that about 20 years back and it's not a good idea. Seems like it would be, but any ambiguity is construed against the insurance company and the classic language that has been used for 100 years or so has been interpreted by the courts so we (meaning the lawyers) all know what it means. As soon as you change it there is no authority interpreting it, I don't know what it means and the court doesn't know what it means. Bad idea.