It's been a couple of weeks since I wrote about my medigap hijacking story and I am sorry to say nothing has improved. The company refuses to acknowledge my spouse hit the medigap F deductible and therefore should be paying the coinsurance claims. They sent a bunch of crap information back that basically was smoke and mirrors. It amazes me how they just stonewall the complaint no matter how much information I provide to prove the case.
I am also amazed how long it is taking for State's Department of Insurance to respond to my complaint. I filed the complaint in the middle of November and when I look on their website they still have not assigned it to an investigator. That says a lot about the state services provided. They must have two investigators to support millions of consumers.
Last week I found another state insurance department - a fraud department. It wasn't obvious that it existed. I Google searched to find it. I sent in a request for a fraud investigation of the insurance company. Who knows if that will result in any action. Even if it does result in an investigation, it doesn't mean we'll get money back from the insurance company.
I suspect this is how this insurance company makes money on medigap F high deductible plans. They tell policy holders they haven't hit the deductible until there is way more coinsurance paid than the actual deductible amount and it's highly likely the policy holder will never notice it. If the policy holder does notice but doesn't pay the providers the providers will send bills to collections so we had no choice but to pay the providers. The goat rodeo that follows to try to get the insurance company to back pay to the actual deductible is impossible. There is no intervening agency that will force them to pay or lose their license to sell policies. All I can do at this point is take them to small claims court. Even then, they can stonewall the payout. Most small claims court awards never get paid.
I will also try to get the Medicare federal inspector general to investigate the company. However, I am pessimistic that the agency will even read my complaint much less do anything about it. There have been many cutbacks at the state and federal level to agencies that support advocacy for consumers because lobbyists keep demanding more "cuts to bureaucracy".
Once again, I lament what IBM did by throwing us into this den of insurance provider wolves. Losing IBM's power to advocate and get insurance companies to behave is a huge loss for us. Just a huge loss.