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ernie · 08-02-2009, 02:23 PM

I have a co-worker whose 3 year old stood up in a shopping cart and fell head first onto the floor in Walmart. The sound was described like a watermelon hitting the floor. They went urgent care here in Missouri and she was assessed to be fine. 5 days later she woke up with a grapefruit sized soft bump on her head. A doctor friend said she needed an immediate catscan. She got it. Then got airlifted to a larger center for further tests and more specialized doctors. Thanfully while she had a blood clot it was going away (and continues to do so 4 weeks later).

You can imagine what this bill is going to be if they get put on the hook with it. Of course the insurance company says "oh no problem it's covered just fill out this paperwork". That paperwork gets filled out and they get a letter in the mail that they have to prove his wife doesn't have healthcare coverage from another provider (she doesn't). They tell them the only thing they need to do is write a letter saying she doesn't have coverage. A few days later anohter letter from the insurance company saying "yeah that letter isn't good enough you'll have to find another way to prove you don't have insurance." So right now they are trying to figure out exactly how to prove something like that. The kicker is if YOU do no get them everything they need to rpocess the claim within 45 days they will not pay it. So this is what they do...give people the run around for 45 days (given my co-workers wife is a nurse she's seen this insurance company behaviour before). Everyone is hopeful things get straightened out in the next couple of weeks. Our HR department has been very helpful in helping them deal with the insurance company the last week or so.

And their insurance company crap even goes to their house insurance. We had a wind storm in May that uprooted 20-30% of the trees in our neighbourhood and caused some roof damage on a number of houses including theirs. They filed a claim to get the work the done and the insurance company dropped them immediately because of too many claims (they had a roof claim from 6-7 years ago...from another storm). Of course then the bank called and said you need insurance by such and such a date or we will reposess the house. So they try to get another insurance company and some won't even quote because of one past claim, some quote outrageous prices and the ones the quote reasonable rates put a clause in that they can't put a claim in for X amount of time. Basically, for them to get coverage they will have to pay out of pocket to fix the roof.

The insurance industry down here is simply out of control.

08-02-2009, 02:23 PM	#101
ernie Franchise Player Join Date: Oct 2004 Exp:	I have a co-worker whose 3 year old stood up in a shopping cart and fell head first onto the floor in Walmart. The sound was described like a watermelon hitting the floor. They went urgent care here in Missouri and she was assessed to be fine. 5 days later she woke up with a grapefruit sized soft bump on her head. A doctor friend said she needed an immediate catscan. She got it. Then got airlifted to a larger center for further tests and more specialized doctors. Thanfully while she had a blood clot it was going away (and continues to do so 4 weeks later). You can imagine what this bill is going to be if they get put on the hook with it. Of course the insurance company says "oh no problem it's covered just fill out this paperwork". That paperwork gets filled out and they get a letter in the mail that they have to prove his wife doesn't have healthcare coverage from another provider (she doesn't). They tell them the only thing they need to do is write a letter saying she doesn't have coverage. A few days later anohter letter from the insurance company saying "yeah that letter isn't good enough you'll have to find another way to prove you don't have insurance." So right now they are trying to figure out exactly how to prove something like that. The kicker is if YOU do no get them everything they need to rpocess the claim within 45 days they will not pay it. So this is what they do...give people the run around for 45 days (given my co-workers wife is a nurse she's seen this insurance company behaviour before). Everyone is hopeful things get straightened out in the next couple of weeks. Our HR department has been very helpful in helping them deal with the insurance company the last week or so. And their insurance company crap even goes to their house insurance. We had a wind storm in May that uprooted 20-30% of the trees in our neighbourhood and caused some roof damage on a number of houses including theirs. They filed a claim to get the work the done and the insurance company dropped them immediately because of too many claims (they had a roof claim from 6-7 years ago...from another storm). Of course then the bank called and said you need insurance by such and such a date or we will reposess the house. So they try to get another insurance company and some won't even quote because of one past claim, some quote outrageous prices and the ones the quote reasonable rates put a clause in that they can't put a claim in for X amount of time. Basically, for them to get coverage they will have to pay out of pocket to fix the roof. The insurance industry down here is simply out of control.