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Senior Contributor

Re: Health insurance

Having read down through all the posts here I am really glad I live in Canada.

We just go for care and then go home and get well.

No bills, no arguing over what is paid or not and not even any insurance premiums.

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Advisor

Re: Health insurance

"I believe the insurance companies spend their time and money figuring out how to not pay claims. My health insurance company is one of the few around which pays a claim the first time they receive a bill."

 

I do have to give Reserve National credit where credit is due.  What we have I consider disaster insurance.  It is mainly to help us when big problems hit.  The little claims we are basically self insured.  They count toward the deductible, but it takes a fai ramount to  It has never failed to do exactly what they said they would do with no hassles.

 

Several years ago we had coverage with  (... I won't name them in order to prevent liable problems for the forum).  We had an incident and they denied every claim.  BUT, if you appealed it they paid every one of them.  I am convinced their corporate policy was to deny every claim in hopes the insured would not pursue it.

 

I went round and round with a company one time when a daughter stuck her arm through a window.  They tried to refuse paying the full amount of the surgeon's bill because it was not "reasonable and customary".  I forget the details now, but I had to appeal the claim more than once arguing it was emergency surgery and there was not time nor opportunity to get second opinions, etc. They finally paid on it.

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Honored Advisor

Re: Health insurance

Emergencies afford special opportunities to learn about health insurance, mike. We had to hospitalize a child with viral meningitis out of state. She was in two different medical centers for three weeks, had a couple of ambulance rides in the mix (two for the trip to and from diagnostics imaging offsite, one for the transfer to MCV). Throw in specialists lined up like crows on a clothesline.

Our insurer refused to pay the claim because we didn't get preauthorization for her admittance...on a weekend, in an emergency, when their offices were closed. She would have been dead by Monday.

That was when one kind claims person informed me of the appeals process, but also one step prior to it, and far less complicated. It was, truly, called " preautzhorization after the fact".

Yes...time travel!

All it actually required was for the neurologist at hospital # 1 to write a letter saying that moving her back to Carolina in her condition would have been life threatening, which was entirely true. And, yes, the insurance agent had said it would be " no problem" using providers in VA, since we are in a border county.

The claim was paid, with only eight hundred dollars on our responsibility. The rest of what it would have taken to settle it was spent then following week on a brand new Honda Accord, her first car, so, quite a difference.
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Honored Advisor

Re: Health insurance

You are so right. If stress delays or complicates healing and recovery, the medical insurance model in the US is enough to kill anyone who has required care.
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