Quote:
Originally Posted by Vana
We never are.
Looks like you are learning a lesson about insurance.
I don't dispute this point.
No capitalist would sell insurance if it wasn't profitable: necessarilly you must never get what you pay for with insurance. Something to think about.
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Well aren't you just a little ray of sunshine
Your final conclusion is wrong: For insurance to function profitably, all that has to happen is that the AVERAGE consumer gets less out than they put in. That's the whole purpose of insurance...to smooth out the spikes in the graph, so to speak. As long as total premiums minus total services paid (and minus business expenses) equals a positive number, they are profitable, even if Jimmy Accident Prone has only paid one months premiums and requires $1million dollars of services. If insurance operated in such a manner that you couldn't 'withdraw' any more than you personally had 'deposited', they'd be no better than a savings account.
Insurance companies safeguard their profits by adjusting their rates according to sophisticated statistical analysis, and by placing maximum coverage caps to limit their exposure on large expenses.
---------- Post added at 11:09 AM ---------- Previous post was at 11:03 AM ----------
Quote:
Originally Posted by The_Jazz
TM - if you're convinced you're in the right, contact your state department of insurance and tell them your problem, especially if you have documentation proving what you've said. Departments of insurance are generally the most customer-friendly state office you'll find because those regulators love nothing better than using their power over companies. I'm not sure which state you're in, but if you need a point in the right direction, just ask.
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I am...the specifics are they cover emergency care in network or out of network at 100% for $150 copay, full stop. However, they're trying to use the 'approved service amounts' or whatever from the 'out of network services' section (from an entirely different subsection of the policy, covering general out of network services, mind you) to only pay their pre-approved amounts for anesthesia and surgery assisting--amounts that are about 20% of the actual charges.
I just got another letter back from the insurance company...the state has a 3-tiered appeals process, but the insurance co said in their last letter that they refuse to deal with any more appeals (after just the first two tiers...the third is 'binding 3rd party arbitration') so I'll give the insurance commission a call this week.