Thumbing my nose at the insurance comapny Options

[mitchntx]

The wife has a breathing problem where as she sleeps her esophagus relaxes too much and collapses when she exhales. It doesn't close completely, but it slows her breathing to a point where her blood/Ox level was down to around 80!

The short term fix is an Oxygen concentrator so that what air she does get is more pure.

Insurance company would pay 80% of a rental after our $1000 deductible was met. After the deductible, our 20% liability was almost $30. They wouldn't cover the cost of a purchase. WTF!

So, I found several sources of these units, both new and used. Purchase price is anywhere from $250 (used with a 1 year warranty) to new at $850. I bought a 6 month old unit for $300 with 3.5 years of the manufacturer's warranty still in place.

I argued with supervisors and managers about them covering the cost of purchase and even submitted an appeal which was denied. They said that they don't cover purchase of major equipment, only rental. I don't understand the thought process.

[BigEnos]

My wife is an insulin-dependent diabetic so dealing with health insurance companies is our least-favorite hobby. She started using a wireless blood glucose monitoring system about a year ago. The insurance companies we've had (and for various reasons we've had about 4 of 'em in the last 12 mos.) have ruled the technology as "experimental" except for blue cross/blue shield. Other than that it's been an out-of-pocket expense for us, and a not-insignificant one either. The sensors are $35/each and usually last about a week. Ultimately we've shouldered the cost because it's been such a huge benefit to her. She was able to attain an A1c reading over 3 months of 6.3 (before that it'd been in the 8s and 9s). No regrets, but it would be great if insurance had/would cover it. Luckily her $8000 insulin pump was covered when she got it.

[cccbock]

My wife is an insulin-dependent diabetic so dealing with health insurance companies is our least-favorite hobby. She started using a wireless blood glucose monitoring system about a year ago. The insurance companies we've had (and for various reasons we've had about 4 of 'em in the last 12 mos.) have ruled the technology as "experimental" except for blue cross/blue shield. Other than that it's been an out-of-pocket expense for us, and a not-insignificant one either. The sensors are $35/each and usually last about a week. Ultimately we've shouldered the cost because it's been such a huge benefit to her. She was able to attain an A1c reading over 3 months of 6.3 (before that it'd been in the 8s and 9s). No regrets, but it would be great if insurance had/would cover it. Luckily her $8000 insulin pump was covered when she got it.

WOW

A1C of 6.3 is HUGE! good work

Worth the price....but it would be nice if the insurance company covered it.

Bock

[marka]

Howdy,

I argued with supervisors and managers about them covering the cost of purchase and even submitted an appeal which was denied. They said that they don't cover purchase of major equipment, only rental. I don't understand the thought process.

#1, insurance companies are stupid. Some of that is understandable (they have to write policies for the general case, not specific instances, so counting on the existence of used equipment, for example, might not work generally), some of it is driven by how someone trying to scheme them could take advantage, and some of it is just because "we've always done it this way" never got anyone in trouble.

#2, I bet rental equipment is something where they don't need to worry about it breaking and then needing to be replaced.

Mark

[mitchntx]

#2, I bet rental equipment is something where they don't need to worry about it breaking and then needing to be replaced.

Mark

That's a good point. BUt rental companies aren't losing money. For the monthly rental, the cost is recouped in 6-8 months depending upon model and accessories.

[GM01SS]

Not much help here...but in New York.........The way it works is.......unit is sent out as a rental for prescribed period ( determined by the insurance Co.). Usually....after 13 months the rental is converted to a purchase. You now own it, but wait............if there is a problem, YOU are responsible for the repair.

It freakin sucks, but that is how "Most" insurance works, @ least here. (IMG:http://www.frrax.com/rrforum/style_emoticons/default/rant2.gif)

Gary

[00 Trans Ram]

That sounds just stupid, Mitch.

I know that insurance companies have to make a profit, just like everyone else. But some of their policies are counterproductive.

Lord knows I'm not a big Obama fan. However, I expect a few things to change (geez, I hate that word) once him and Tom Daschle get in charge of healthcare. One of the things is that the nation (at least, the insurance companies and healthcare providers) will start focusing on preventative care.

If logic follows, then machines that help people stay healthy and out of ER departments will be much more likely to be covered.

[mitchntx]

Let's see, 150/month x 13 months equals $1950. I can buy 6 of these things over a year's time.

If the machine was life supporting then I can see having a machine available that would work regardless of cost. But my wife's condition is not that dire. If the machine conks out, we send it in for repair or scour craig's list for another. In the mean time, we can get a prescription for a rental unit in the interim.

[marka]

Howdy,

Let's see, 150/month x 13 months equals $1950. I can buy 6 of these things over a year's time.

If the machine was life supporting then I can see having a machine available that would work regardless of cost. But my wife's condition is not that dire. If the machine conks out, we send it in for repair or scour craig's list for another. In the mean time, we can get a prescription for a rental unit in the interim.

The insurance company is not worried about saving money, they're worried about limiting cost.

I.e. they'd rather pay more for a rental unit because its a fixed monthly cost that never changes and is hard for you to game so that you scam them for money.

In comparison, them reimbursing you for equipment that you own is much more problematic. Machines break and need to be repaired or replaced, particularly used machines. So you buy one, get reimbursed, and it breaks two months later. So you buy another, etc. Meanwhile, did it _really_ break or did you just sell the old one? How many should they replace before they cut you off? Guaranteed that whatever # you pick, some grandmother will trip the policy and be in the paper the next day about how the insurance company is a big bunch of fuckers that are out to get her.

In a lot of ways its the same reasons why some people lease cars rather than owning them. Just like that, its a lot more about predictibilty of costs rather than lower costs.

Mark

[CrashTestDummy]

AND limiting their liability exposure. The rental belongs to another company (even if it is a subsidiary of the insurance company). If something goes wrong with the hardware, you, and possibly the insurance company, sue the owner of the hardware. If you buy it, it's yours. If the machine fails, and causes injury or death to a loved one, the manufacturer, or company who sold the hardware are one step away from being liable, and only if you, or your lawyers, can prove the hardware was defective AND operated correctly. If not, it's your problem, and probably your insurance company's for allowing you to purchase said bad hardware.

Any chance they can say 'Not it!', they will, and rentals, although possibly more expensive in the short term, can be a LOT cheaper then having to fight a multi-million $$ lawsuit.

Cynic switch on: and oh yeah, what Mark says about the whole 'gaming them' thing. Yeah, when it comes time for them to pay out some of _their_ hard-earned cash (it's really not yours any more), they want to make sure they don't give up any more than they have to. Every customer is a potential crook, in their eyes. I guess it takes one to know one.
Cynic switch off:

Having watched all the tricks the insurance companies and mortgage companies have played after Hurricane Ike has made me reconsider a lot of this insurance stuff. It just makes you shake your head in disbelief.

<SNIP>
The insurance company is not worried about saving money, they're worried about limiting cost.

I.e. they'd rather pay more for a rental unit because its a fixed monthly cost that never changes and is hard for you to game so that you scam them for money.

In comparison, them reimbursing you for equipment that you own is much more problematic. Machines break and need to be repaired or replaced, particularly used machines. So you buy one, get reimbursed, and it breaks two months later. So you buy another, etc. Meanwhile, did it _really_ break or did you just sell the old one? How many should they replace before they cut you off? Guaranteed that whatever # you pick, some grandmother will trip the policy and be in the paper the next day about how the insurance company is a big bunch of fuckers that are out to get her.

In a lot of ways its the same reasons why some people lease cars rather than owning them. Just like that, its a lot more about predictibilty of costs rather than lower costs.

Mark

[mitchntx]

I see the points made. I guess if I were a crook ...

Bottom line is ... well, I guess I watch mine just like they watch theirs.

[BigEnos]

It's all fun and games with the insurance company until there's a big payout requested. Then they start playing rough. My wife was leaving a job where the insurance covered her pump supplies at 100% so she wanted to get everything she was entitled to per the plan guidelines before she left. About a week before the insurance ran out she ordered about $700 worth of supplies and about a month later we started getting the "denied" letters. She'd call and they'd "resubmit" her claim and it would magically come back denied again. After going around with them a few times about how she was, indeed, covered at the time they asked her to prove it. She faxed them a letter they had sent to her showing proof of coverage. (She was smart enough to request it before she ordered supplies) Magically, the problem went away.

Punchline is, the insurance company knew full-well she was covered but denied the claim because they didn't think she could prove it. It's done as a matter of policy and it's borderline criminal in my mind.

[98_1LE]

Mitch, my dad has been using a breathing machine to sleep for years (his mother suffered from and eventually succumb to sleep apnea). He "rolls his own" to some degree; let me know if you want him to call you to discuss.

I don't think he would build one for liability reasons, but it might be worth the experience/advice.

This post has been edited by 98_1LE: Jan 5 2009, 09:18 PM

[00 Trans Ram]

The story may be on here, or if not then I'm sure I'll post it up one day. Suffice it to say that I fought Allstate over about $75 worth of damage to my car (another $75 worth of damage and the car would've been a total loss).

Here are a few tidbits:
- lower-level and even mid-level employees cannot and will not make decisions that run counter to company policy
- be nice to everyone you talk to; it throws them off their game (Allstate actually noted in my file that I was a "nice guy, easy to talk to, very logical")
- document everything (and I mean everything - record phone calls, keep multiple copies of files, etc.)
- know the law inside and out, and have copies of it so you can refer to it while on the phone
- if, at any point, they begin doing things that are unethical or illegal (not just unfair) draft a complaint to your state Department of Insurance; in your complaint, explain the problem thoroughly and include all documentation (taped conversations, documents, etc.)
- talk to people on the phone every day (2 things - first, people will begin to realize that you aren't worth the trouble; second, people are likely to slip up and say something wrong, whereas writing or typing allows them time to think before hitting send)

Was I ultimately successful in my efforts? No, I was forced to keep my car. However, I was able to convince the Department of Insurance to censure Allstate and force them to change the way they calculated damages on all cars in the state. I ended up being $75 short on damages, and I simply could not find any other damaged parts (I wasn't going to fraudulently make up something, either). So, did I get what I wanted? No. Did I win? I think so.

[souseless]

Maybe Law Motorsports could go into the oxygen machine rental business......

[mitchntx]

Maybe Law Motorsports could go into the oxygen machine rental business......

LOL ... don't think I didn't consider it.

But a couple things got in the way ... a conscience and a soul. (IMG:http://www.frrax.com/rrforum/style_emoticons/default/dry.gif)

[00 Trans Ram]

Maybe Law Motorsports could go into the oxygen machine rental business......

LOL ... don't think I didn't consider it.

But a couple things got in the way ... a conscience and a soul. (IMG:http://www.frrax.com/rrforum/style_emoticons/default/dry.gif)

Yup - gotta check those at the door if you want to work for insurance!