Holy cow ... sometimes being unwilling to "let it go" pays off!
I got the mail tonight and the cheapo medigap insurance company capitulated!!! They paid the claims they were supposed to pay. Unfortunately, they paid the providers (who had already been paid) so we'll have to wait for the providers to refund us the money. BUT ... they paid!!! And it was more than I thought it was ... about $1,500.
I think the magic words I used in my last letter to them was that what they were doing was Medicare fraud and I would be filing agency complaints. What a pity that it took such words to push them into action.
Meanwhile, there are others out there that are being cheated and they don't even know it. I sure hope the agencies I complained to will not treat this as a "closed case" and still investigate this company.
I also hope I have helped someone who is reading this blog to learn how to deal with insurance companies. Keep reading the statements they send to you. You have to work at understanding the statements and if it doesn't add up ... challenge the company. Use the threat of involving state and federal agencies to support your case.
Clearly, if I had been wrong about their processing of the claims they wouldn't have paid them.
Here's the crazy part ... no explanation, no apology ... just a bunch of processing forms arrived that showed they paid a bunch of doctors money. How guilty is that?
Beware ... insurance companies are ruthless.
Update: The cheapo insurance company sent a letter on December 24, 2014 explaining what happened. They said they made a "clerical error". They said they provided a more detailed explanation to the NYS Department of Insurance and have recalculated the deductible. Those rascally clerical errors and incompetent clerks just cannot be trusted.
Monday, December 15, 2014
Sunday, December 14, 2014
IBM Medicare OneExchange Medicare Supplemental story continues
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.
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.
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