Employers use federal law to deny benefits
 

I came across this rather disturbing and depressing news item, and thought I'd share it.

http://www.usatoday.com/news/washing...-battles_N.htm

Insurance companies, and sometimes by extension the companies who employ their services, often look long and hard for reasons not to pay a claim.

Oh we're sorry. You went to United South instead of United North Hospital so your claim is not being paid. Doesn't matter both hospitals are owned and run by the same group with the same fees and everything.

Oh sorry. You only gave us 23 1/2 hours notice prior to your surgery instead of 24. You benefit is reduced by 70%.

No we are not going to pay your claim because you failed to notify us 48 hours prior to being admitted in the hospital. It is not our fault you got sick 800 miles from home, slipped into a coma and did not have any ID on you to let people know who you were.

Oh sorry, we do not cover the treatment for your disease since your condition is so rare that only 1 in 3 million people have it and because of its rarity we consider the treatment to be experimental. Yes we know the treatment has been used since 1847, but it is still experimental since it is rarely used and little official testing has been done on it.

Stories like this astonish me. The premiums were paid with the reasonable expectation that should a claim arise, the claim would be paid. If these folks had an indication any claim would be denied under any circumstances, they should have been advised of that and given the oppurtunity to shop elsewhere for insurance.

Where is the expectation that anyone would need to hire an attorney to evaluate a benefit plan . . it's supposed to be a BENEFIT and is usually the only plan offered by an employer . . to determine it's suitability for your particular circumstances?

The law is supposed to be fair. For you legal buffs, many of the countless "fleece" lawsuits won and/or settled by the likes of OOIDA were successful because the courts reasoned the fleece terms to be so intrinsically unfair and so heavily weighted to favor the company, no one in their right mind would sign the lease UNLESS it had been offered by a current or potential "employer".

Re: Employers use federal law to deny benefits
 

Definitely a wake up call! Hopefully it will serve notice to some of us to take extra steps to ensure that our affairs are indeed in order to the best of our ability.

That "man behind the curtain" sure does get around. :evil:

Benefit Denial
 

Has it occured to anyone that the "law" was written by lawyers (elected senators/representatives, party affiliation making no difference) who actually don't know how to author good law and may be in cahoots with companies (insurers/employers) who contribute to their campaigns? BOL

Re: Benefit Denial
 

If you're talking about Obama, that even VOTED AGAINST his own bill, I suppose, but take a look at a much larger picture.

The late founder of Century Insurance made a statement that he was weathy enough that he could put ANY MAN INTO THE GOVERNOR'S SEAT NO MATTER HOW THE PUBLIC FELT ABOUT THE MAN. Now, carry that a little further. $1,000 a plate fund-raising dinner... $100,000 donation to the Republican Party and you sit in on the PLATFORM COMMITTEE. $200,000 to the Democratic Party for the same priviledge. Now please tell us just who can afford that. How about insurance executives? And, the laws are written by people that have NEVER HAD TO WORK FOR A PAYCHECK... Is it any wonder that the laws are written in favor of the insurance companies?

Re: Benefit Denial
 

It is in that spirit that I started a new thread . . Joe America Speaks.

Please give it a look and a comment and, by all means, pass it along.

Re: Benefit Denial
 

so when you are elected president, what are you going to do about it?

Re: Benefit Denial
 

Take the insurance companies OUT of the decisions about the healthcare that a patient gets. The doctors and the patients get to make the decisions, and the insurance gets to cover the costs. The same goes for HMOs. Currently, the insurance company gets to dictate that "THE PATIENT DOES NOT NEED THAT PROCEDURE", or that the procedure is "EXPERIMENTAL", and they will not cover it. That is not the insurance company's choice to make. That choice belongs to the person whose life is at stake, and the care-giver.

People all over the country have died because the insurance company, or the HMO decided that the patient did not need a certain test. Then, a year later, when the insurance company finally said to give them the test, it was too late. I had an uncle that fell victim to this. And, the insurance companies NEED to be held liable for things like that. If the doctor can be sued for mal-practice for making a wrong decision, then if the insurance company is going to get involved in that process, they become liable as well.

If insurance companies are going to meneuver themselves to where they have a "CAPTIVE AUDIENCE" (manditory insurance), then they are not allowed to make many decisions about the coverage or premiums. If insurance is voluntary, they can have a wider range of options, until it comes to health insurance.

Insurance
 

"Take the insurance companies OUT of the decisions about the healthcare that a patient gets." And the companies will quit writing health insurance. One of the problems I've seen with buying health insurance, you have to coverage for what you don't need. Why would a single male have to buy obstetrics (pregnancy) coverage? State governments require it, makes no sense.
Be careful what is asked for, the VA and military medicine aren't covered in glory sometimes. You can be sure, if health insurance goes single payer, there'll be a Feres Doctrine to keep the government off the hook for medical foul-ups. BOL

Hell - I'm ready to drop my health insurance completely...

My company is fairly small - 65 or so company trucks. I was paying $110/month for health insurance for myself and my wife. Starting July 1st, our insurance went up to $250/month.

Mind you it also has a $5,000/year deductible per person, $20,000/year deductible per family.

Great, isn't it...

You need to read all the fine print before you sign any document, especially when it comes to insurance. Some policies have so many exemptions you have to wonder what they actually cover. Insurance companies continue to raise premiums while cutting coverage. I have been looking at policies recently. I am amazed at how much variance I see from one company to another. You really need to read ALL the information CAREFULLY. The last thing you need is to have to go to the hospital and find out after the fact that you have little or no coverage.

If you think coverage is bad now, just wait until the government puts in national health-care. The only people this will help are the insurance companies and politicians. It will create yet another bureaucracy that we don't need. Most politicians are lawyers. These lawyers have basically given away this country for their own profit. Insurance companies have no business making medical decisions. It should be up to the patient and their physician. The insurance company only needs to write the check.

The movie "sicko" by Michael Moore is a good one.

Re: Benefit Denial
 

NAH, that wouldn't happen in the US!

Actually our elected representatives don't write the legislation which bears their name. They employ other lawyers to do that for them. I have been told that there are more lawyers in Washington DC than any other city in the nation. Would you care to guess who they work for? :shock: