Quote:
Originally Posted by Tully Mars
I can't speak about death panels because, well that just sounds like BS to me. But I call BS on "If a procedure or condition isn't covered it is stated clearly in the policy that is issued." I had the same procedure 10 or 11 times on my spine, nerve block, in an attempt to repair nerve damage in my leg. This was clearly covered in my policy. My insurance, Cigna, covered the first, kick back the second without reason, paid for the four and fifth and then paid for, I think, the eights. Now these procedures weren't questionable, three doctors told me this was the correct course of action. The insurance folks used excuses like incorrect coding, non preapproval etc... All of that was Bull Shit. They fought tooth and nail not to pay for the ones they rejected. I had to hire an attorney to get them to pay. I was lucky. I had the cash to hire legal help, lots of folks don't.
So to think that "insurance companies don't decide not to cover someone" that it's all in the policy, it's cut and dry. No they try to get out of every out pay they can. I had one lady at the insurance company literally tell me they'd been told to reject X number of claims and that their pay was increased (by bonus) if they successfully rejected a certain number of claims.
These health insurance companies that are spending major cash lobbying and getting this "Astroturf" movement moving are doing so out of fear they'll lose the option of bilking billions out of their policy holders. They want no part of a public option because they know to complete with it they'll have stop feeding at the trough.
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While your circumstance is a terrible one this is not general practice across the board. There is shady practices in insurance no question, but there is in virtually every business because those businesses are run by PEOPLE. I can't speak for cigna or the people that work there since I'm not employed by them, but with my company, we will deny a claim based on a few very specific reasons: a)was the policy in force at time of incident? b) was the injury or loss specifically excluded in writing on policy? and c) was the injury or loss intentional or occur during the process of a felony?
---------- Post added at 08:18 PM ---------- Previous post was at 08:10 PM ----------
Quote:
Originally Posted by Rekna
Ever heard of rescission? Look it up.
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rescission has nothing to do with denying a claim. It has to do with cancelling a policy, which is limited to very few specific circumstances. One being lieing on an applicaiton