Health insurance recission

[widebody911]

I learned something today...

http://tauntermedia.com/2009/07/28/unconscionable-math/

If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population). If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population. If, as I suspect, rescission is targeted toward the truly bankrupting cases – the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier – then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette.

[Moses]

Rescission, service denial and claim rejection. In 20 years I have seen some unbelievable stuff. Don't know how they sleep at night.

[Moses]

And another thing... Why is rescission legal? Why was it ever legal?

[Burnin' oil]

Thom, what did you learn? It appears to me that the rate of rescission increases as the costs increase but math and logic make my head dizzy.

[NICKG]

the insurers live to deny. case in point:
my wife had an epiderul for a pinched nerve
prior to the procedure she:
verified the procedure code was covered
verified the dr was covered
verified that the Anestesiologist (the real crook ) was covered
verified that the facility was covered

she then :
had all the verifications REDONE by:
The dr performing the service
the anestesiaologist
the facility

she then:
REVERIFIED again keeping track of names of the people she spoke with

she then:
has service done knowing ALL costs to us that we would be responsible for.

what happened?

BCBS denies the claim for:
unapproved service
out of network dr (the anestisiaologist)
out of network facility

we get a $3500 bill JUST for the facility...where she was at for less than 25 minutes.
Now the dr's offices are scrambling as are the facility's as we ALL verified the procedure. The facility wants to get paid, they have a collection dept that is not backing off us owing 3500

our payment was SUPPOSED to be $400
result?
my wife cannot get the other 2 epidural to help her back/neck
so she is in constant pain

I am livid with the insurance company and they don't care. I pay $12k a year and am afraid to see ANY dr because they ALWAYS screw the billing up and i have to fight.

[Burnin' oil]

Originally Posted by Moses

And another thing... Why is rescission legal? Why was it ever legal?

Moses asks life insurance guy for a million dollar policy and claims to be in the peak of health, but knows that he actually has a terminal illness with less than two years to live. Rescission by life insurance guy might be appropriate, no?

Health insurer decides to rescind X% of policies in which claims reach a certain dollar amount to avoid further liability and bases the rescission on grounds that exist with virtually every policy holder. On its face, each rescission might appear to be appropriate, but collectively, not.

[Amail]

Originally Posted by NICKG

...snip
BCBS denies the claim for:
unapproved service
out of network dr (the anestisiaologist)
out of network facility

I just went through this with CareFirst in MD, who is a BCBS provider. Wife had knee surgery in Nov 2008, but payment wasn't made until June 2009. Lots of back and forth, never the same person to talk to, always "under review" or "open investigation" or some such nonsense.

What got my situation turned around, and I mean RIGHT NOW, was telling them my attorney was recommending a bad faith refusal to pay a claim lawsuit. Advice I got right here from the PPOT braintrust. I had a check within 10 days of telling them this.

Our situations may be different in that I wasn't denied coverage, they were simply dragging their heels bigtime.

[NICKG]

thanks, that is where it is going. I told ALL parties that in Nj a verbal contract had been verified and they were not going to do this to me. I told them that I WOULD spend the $ to hire an attorney for EXACTLY that if i had this go on any longer

[TechnoViking]

I had a HUGE battle with my insurance co. over a LASIK benefit that they touted at a company meeting. Saying you have a benefit available is one thing. Getting *paid* by the insurance co. is a whole other thing. It took at least 5 hours of phone calls, waiting on hold, talking to supervisors, calling my company rep., calling the eye doc's office, filling out additional forms, having the eye doc talk to the insurance co., etc. But I did get paid in full after about three months.

Insurance is a racket. Getting them to pay is like pulling teeth. The LASIK thing was very educational for me. I've come to the conclusion if I ever have a major illness I pretty much going to need a lawyer

Edit: noted, my post was not about rescission, but still