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  1. #8031
    FORT Fogey PGM35's Avatar
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    Re: Talk about your troubles

    We found out (my small company that I work for and act as Insurance admin) that our insurance can charge us up to 49% more each year and not have to have a good reason. Also, they cannot use a medical issue of one of our employee as the reason, however, they see the claims, know the medicines, and specialists the employees see, so they figure out the medical issues and raise the rates according to that, even though legally they "shouldn't" be. It makes no sense and it hurts us as employees b/c our bosses cannot afford to pay insurance for us anymore. They want to up our deductibles to pay lower raters but the deductibles are what we need to meet in order to have the insurance pay major claims. So a $1500 procedure will cost me meeting my deductible of $2000 before they will pay any of it.

  2. #8032
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    Re: Talk about your troubles

    Quote Originally Posted by myrosiedog;3463252;
    Noreality, I feel your pain. It's ridiculous the insurance rates we have in this country and I have heard nothing but good stories from people that hail from countries with socialized medicine.
    MRD et al, think of this as universal health care... seems like a normal concept in many parts of the world. Like taking care of roads, police, etc.

    In my family, we hope and pray that only one of us needs to meet the deductible in a year. This is my year and I am getting new glasses. My husband needs to keep his body together this year.

  3. #8033
    Jumpin' George Clooney NickNack77's Avatar
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    Re: Talk about your troubles

    Quote Originally Posted by captain;3464032;
    If you are in an accident, not your fault, if there was no insurance requirement who would pay to have your vehicle repaired? I know most people would pay if at fault or there is always a lawsuit.
    As for the car accident, the 2nd vehicle is at fault for following too closely.
    That is a VERY trusting way of believing the insurance industry's advertising.

    The fact of the matter is, it is FREQUENTLY the case that innocent people (not at fault) are in accidents, and the insurance company doesn't pay a dime. It's just like the woman whose husband needed air transport--the insurance company just has some hack on the payroll that says, yeah, you were at fault, so we're not going to pay. It's a total scam.

    I mean, have you ever wondered why the insurance companies can afford to sponsor so many football bowl games? That's our money they're using to pay for football games instead of taking care of people.
    "The day will come when, after harnessing space, the winds, the tides, gravitation, we shall harness for God the energies of love. And, on that day, for the second time in the history of the world, we will have discovered fire."

  4. #8034
    Jumpin' George Clooney NickNack77's Avatar
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    Re: Talk about your troubles

    Quote Originally Posted by myrosiedog;3464723;
    When my friend was dying of cancer, he and his wife both spent a GREAT deal of time dealing with the insurance company. That's not right, you shouldn't have to . . . she had paid into this insurance for many, many, many years and they took her money, but weren't willing to give it up to actually pay many of the claims.



    That's exactly how insurance companies operate. It's just not right. Right now, the law says insurance companies owe their highest duty to their shareholders, but that's not why we have insurance. Insurance is to protect society, so ultimately their highest duty should be to pay proper claims ASAP.

    Just look at all the horror stories here. The system is broken. It needs to be fixed.
    "The day will come when, after harnessing space, the winds, the tides, gravitation, we shall harness for God the energies of love. And, on that day, for the second time in the history of the world, we will have discovered fire."

  5. #8035
    Anarchist AJane's Avatar
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    Re: Talk about your troubles

    Quote Originally Posted by PGM35;3464963;
    We found out (my small company that I work for and act as Insurance admin) that our insurance can charge us up to 49% more each year and not have to have a good reason. Also, they cannot use a medical issue of one of our employee as the reason, however, they see the claims, know the medicines, and specialists the employees see, so they figure out the medical issues and raise the rates according to that, even though legally they "shouldn't" be. It makes no sense and it hurts us as employees b/c our bosses cannot afford to pay insurance for us anymore. They want to up our deductibles to pay lower raters but the deductibles are what we need to meet in order to have the insurance pay major claims. So a $1500 procedure will cost me meeting my deductible of $2000 before they will pay any of it.
    I can explain this a little bit. The insurer charges premiums based on actuarial data, which measures risk. If you're talking about group benefits (for employees of an organization/company) then the risk is assessed, generally speaking, on the size of the company (larger pool of employees=risk is spread out more), the average age of the employees, and the nature of the business. Construction employees who are for the most part middle-aged, for instance, will pay a higher premium than an office of 20-something payroll clerks.

    Claims experience plays a significant role in assessing renewal rates. Basically what happens is that when the policy approaches renewal, claims experience for each benefit - for example, physiotherapy - will be displayed, with a breakdown for what was paid out in claims and what was charged in premiums. However, the decision to charge a higher rate is not as simple as the insurer seeing a loss on their side. Many factors play into rate increases - is this a good client? Do they pay their premiums on time? Are increased claims this year a fluke or are they climbing steadily? How long have the clients been with the insurer? Rates can be re-negotiated when considering these other factors.

    Sorry for the insurance lecture. Though I'm not in the business currently, I spent 20 years in different aspects, working for companies and consultants. I've fought on behalf of clients to get difficult claims paid and helping others make sure they have affordable plans for their employees. I know the insurance business strikes many people as unfair - so without defending poor business practices, I hope this helps make sense of your predicament, PGM. Our Canadian healthcare systems makes such high deductibles unnecessary, so catastrophic events (i.e., a client with cancer, collecting disability and using expensive medications) don't have the same impact on insurance coverage here as they would in the U.S. I hope you and your employer are able to negotiate something that everyone can live with.

    NickNack - don't forget insurance companies are for-profit organizations. Their first responsibility really is to their shareholders. The responsibility of "protecting society" belongs to the government. When or if universal healthcare becomes reality in the U.S., then insurers will have to respond by coordinating benefits and costs will be adjusted depending on the extent of the coverage a new system will offer the citizens.
    Last edited by AJane; 05-23-2009 at 05:03 PM.
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  6. #8036
    FORT Fogey norealityhere's Avatar
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    Re: Talk about your troubles

    I spent many years in the insurance industry and still maintain my insurance license. While I fully understand the underwriting / actuarial / risk concepts involved, I would say that this is 1 industry that has been allowed to go unchecked in the US in a very similar manner to the way the banking industry has been. One recognizes that these are "for profit" companies, but the profits have been astronomical. Most states have regulations that exist for comapnies in regard to auto insurance, but no such thing exists for medical insurance. The medical insurers in the US have so convinced the public that they would suffer tremendously without them if the US put in - god forbid - socialized medicine aka universal healthcare, that a large majority liken socialized medicine to "no choice, long lines, long waiting periods" medicine. Consumers need to realize that the managed care concept of health insurance we have in the US right now is set up solely to benefit the insurers and not at all to benefit policyholders.
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  7. #8037
    Anarchist AJane's Avatar
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    Re: Talk about your troubles

    Quote Originally Posted by norealityhere;3466002;
    Consumers need to realize that the managed care concept of health insurance we have in the US right now is set up solely to benefit the insurers and not at all to benefit policyholders.
    It really is shocking to me how U.S. insurers dictate the course of medical care. It's really hard for me to wrap my mind around your system and the method of doing business.

    There's still a big role for insurers in a universal healthcare system - many services aren't included in our provincial coverages (and those do vary from province to province). My own various roles in the industry have always been client-based, with the main focus being the facilitation of claims payment. I'm sorry to hear that it seems that U.S. insurers don't provide representatives who will take the role of advocating for their clients. I think that is an important service and a valuable one, even more so for Americans who don't have the advantage of universal healthcare.
    All my life, I have felt destiny tugging at my sleeve.~ Thursday Next
    I don't want to "go with the flow". The flow just washes you down the drain. I want to fight the flow.- Henry Rollins
    All this spiritual talk is great and everything...but at the end of the day, there's nothing like a pair of skinny jeans. - Jillian Michaels

  8. #8038
    MRD
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    Re: Talk about your troubles

    It seems the only advocates for clients of an insurance company in the U.S. are lawyers and lawsuits.
    There does need to be regulation in the insurance business. But as we've seen in the last 30 or so years is a lot of deregulation in business that has led us to the point we are in now economically.


    And if you think health insurance is high and a scam, then try to get homeowners insurance in Florida post the 2004 hurricane season. Most are paying homeowners rates equal to their mortgages, IF they can find insurance. I think at the moment only 3 companies are actually writing policies in Florida and one of those is the state run insurance fund that was put in place for those that couldn't get insurance through a regular company.

    Because of the high profit margin in insurance and the insurance and medical lobbies, gettting any type of universal health care in this country is going to be next to impossible. I would love to see it, but I don't think Obama's administration will have much success with it either. President Truman in the 1940's first proposed a universal health care system for this country. Here it is now 60+ years later and we still don't have one.
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  9. #8039
    Jumpin' George Clooney NickNack77's Avatar
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    Re: Talk about your troubles

    I agree that lawyers are about the only advocates who even try to keep insurance companies in line. Nobody else seems to vote against insurance companies when someone tries to pass a law reforming regulation on them.

    I also fully understand that insurance companies under current laws are run as for-profit entities, but it doesn't have to be that way.

    See, the thing that bugs me a lot about insurance companies is how they've managed to get the government to pass laws requiring under penalty of law that we buy their insurance. That's certainly true of no-fault and automobile liability coverage. Try explaining to the nice police officer that you don't have insurance the next time you get pulled over--you will get at least a ticket and might even end up in jail.

    So what reason did insurance companies give for requiring us to buy their product? That it protected the public at large. And courts and lawmakers have believed that line ever since.

    But insurance companies do NOT treat all insurance claims alike. If you are an innocent member of the public hurt in a car crash (and therefore clearly within the definition of the "public" that is supposed to be protected by legally mandated insurance) you are what they call a "third party"--and "third party" insurance claims are not subject to the same duty of good faith and fair dealing that "first party" insurance claims are entitled to (like life insurance or homeowner's insurance).

    Therefore, insurers like Allstate and State Farm have adopted really hard-ball tactics that essentially FORCE everyone to hire a lawyer and sue them in order to collect on a perfectly legitimate claim.

    Secret documents about Allstate and State Farm's abusive practices have come to light, but the news doesn't make much of them, because the insurance companies pay so much advertising and sponsor so many televised sporting events.

    It's positively corrupt, I tell ya.
    "The day will come when, after harnessing space, the winds, the tides, gravitation, we shall harness for God the energies of love. And, on that day, for the second time in the history of the world, we will have discovered fire."

  10. #8040
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    Re: Talk about your troubles

    Quote Originally Posted by norealityhere;3463026;
    Thanks, Ellen, I will do just that.
    None of the Europeans I've ever met told me any medical horror stories to rival the ones we have in this country.
    I lived for 6 years, gave birth to my twins, in Scandinavia. Finland to be precise. Everytime I hear one of those wing nuts talk about the scandinavian welfare state as some bad thing, I could scream. The health care system wasa top of the line. No, I did not have to wait, and yes I could choose where to go. Maternity leave is a given with birth, and can be followed by either parent choosing additional time. There are permanent subs to take positions of those on leave. Unemployed workers get 60 percent of salary so no one loses their home. The population is 100 percent literate and over 65 percent go to college, which is free, and students test among the highest in the world. (and it does not start till 7 so kids get to be kids). And yeah, the taxes are high, but no higher than I now pay in NYC where by the grace of whatever, my government position gives me great benefits , but where the majority of my taxes do not go to education, or health care, or infrastructure...but for military and corporate welfare. If I had to choose between social welfare and corporate welfare, given me the former anyday.

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