Saturday, September 5, 2015

Dances With Insurance Company

Argument over a Card Game
Jan Steen (Source)
As many (most?) of you know, I had surgery back at the end of July. I spent nearly a week in the hospital and have been recovering at home ever since. I'm on what's called "Short Term Disability." Yes, my employer and Little Rhody both refer to this state of being as, wait for it, "STD." Which has other, rather unpleasant, connotations. So I won't use that acronym, ever.

Well, except the one time, just now. Because I had to explain it and I thought it funny. Yeah, I know, don't quit my day job.

So I have two insurance companies, one for the medical stuff, think "they pay the hospital bills" and one for the paycheck thing, think "they pay me."

Because I reside in Little Rhody, who have their own disability insurance, I pay some to the state and some to the insurance company. My employer pays a lot to the state and to the insurance company. The idea is that when I can't work, I still get paid. Though it costs a bit extra, I pay in so that if I am disabled for a short period of time (up to 13 weeks) I get 100% of my pay.

Good deal, right?

Well, it can be, and here's the rub. The doctor will tell you when you can go back to work, let's assume that he says "eight weeks." Now the insurance company (who are now in a position to have to give you back money which you paid in) says, "Uh uh, you need to go back in four weeks."

My experience is that whatever the doctor says, the insurance company will cut in half. DAMHIK. Been there, done that.

So who does one listen to? The doctor is concerned that you will screw up your health and well being by going back to work too soon. The insurance company is concerned that you are costing them money.

Pikers, that's what insurance companies are.

I view insurance as a bet, you put your money down, betting that you will need the insurance at some point in time. Whether it's a car accident, health issue or even (egad) death in the case of a life insurance policy.

Now the insurance company is betting that they will never have to cut you a check because you are one really healthy / careful / long-lived dude.

Do I complain at the end of the year when I lose my bet? "Gee, the insurance company gets to keep all that money." No, I say, "Thank the Lord we didn't have any accidents / health issues / (egad) deaths in the family."

Now on the other hand, the insurance company, when they lose the bet, try to wiggle out of the full amount. It's almost as if they're saying, "C'mon Sarge, best two out of three?" Nope, they really don't want to pay. Now by law they have to, so they will try and get away with the least amount that they can.

Now earlier this week, after telling the insurance company that my doctor wanted me to chill out until the end of September, they called me back later and said, "We have you going back to work on September 7th." Dude was awfully rude about it too. Apparently their spreadsheet shows most people after the surgery I had go back to work in four weeks. I pointed out, again, what my doctor had told me. His answer, "Why should you get more time off than anyone else?"

Dude, doctor's orders, what more can I say? I was flabbergasted, gobsmacked, stunned and annoyed. Who is this dipstick who thinks he can override my doctor? And be a complete Richard about it!

So I called back , got a different person, a very pleasant lady who concurred with my assessment of her colleague being a Richard and transferred me to the dude's supervisor. She was also very nice, was upset that -
  1. Her subordinate treats customers badly,
  2. This was also the second time I had filed a claim, (they claim to have lost the first, or "forgot to save it") and
  3. That I was most upset with her employer.
This company has a track record of doing this. I figure most people will just say "Okay" and head back to work, like sheep. Some of us though will fight back.

True story time.

Friend of mine one day at work had to run down to the head, seems he had a nose bleed. When he didn't return right away, I headed to the head myself to check on him. Upon arrival my buddy wasn't there but a facilities chap that I know was there, cleaning up a sizable amount of blood from one of the sinks and the floor underneath. Seems my buddy had to be rushed to the hospital. It wasn't just a nose bleed, he had popped a blood vessel in there.

While he was in intensive care, hooked up to a ventilator, unconscious, our friends at the insurance company called his wife...

"So when do you think Jim will return to work?"

Yes, Jim's better half blew her stack.

"I DON'T KNOW. I'LL ASK HIM WHEN HE REGAINS CONSCIOUSNESS, PROVIDED OF COURSE THEY TAKE HIM OFF THE VENTILATOR!!!!"

The idea is to cut costs, hustle the subscriber back to work as soon as possible.

I mean I get that from a business perspective. What I don't get is how they can override medical professionals.

Then I had an epiphany.

My going back to work is a medical decision, made by my doctor. Whether or not the insurance company has to continue to pay me disability is a LEGAL issue. I pointed out to them that they didn't get to decide when I went back to work, that was between me, my doctor and my company. All they could was cut / or not cut a check to moi.

Yes, that got their attention.

While I'm sure my observation had nothing to do with it, they deemed the information they received from my doctor to be insufficient, but because Monday is Labor Day, they can't really expect me to return to work the day after. Right now their target date is the 14th. I talked to my doctor's office on Thursday, they were pissed. Seems they are used to this really shoddy practice by the insurers. And they don't like it. More paperwork dontcha know?

Oddly enough, the checks from Little Rhody started coming in the fourth week I was out, got another one today. Seems the state is content to believe my doctor. What the Hell is wrong with my insurance company?

In reality, it's just another way to harvest other people's money.

It's a wager, you're betting you'll need your insurance, they're betting you won't.

And the house always wins.

18 comments:

  1. Chris, I think this would be an appropriate time to write a letter to your state insurance commissioner (or whatever they call it in RI) and lay out the facts. Insurance companies have to be licensed in the state to do business there. The job of the insurance commission is to keep them honest. As they used to say in the Army Special Forces, once you have them by the balls their hearts and minds will follow. See if you can get the commissioner to get a grasp on the problem.

    ReplyDelete
  2. Perhaps a letter from your doctor stating that if you were forced (financially) to go back to work before the opinion of medical professionals and you experienced any negative medical problems as a result of being forced to ignore best medical practices he (she) will certainly be a witness for the patient in any suit or legal action initiated as a result of said insurance companies malicious behavior against the advice of the medical community in favor of saving money.

    Such action might cost the company an expensive settlement along with a negative public relations hit. These are considerations they need to factor in to their risk evaluation.

    ReplyDelete
    Replies
    1. That's why when a subscriber stands on their hind legs and disagrees, they usually buckle.

      It's the new American way, don't do your job, just say no. Most folks bow their heads and comply. I'm not like that.

      Delete
  3. I sue disability insurers for refusing to pay benefits. It keeps me in beer and skittles. You know where to find me.

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  4. I would tell them I'll see them in court if they don't pay withing x days.

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    Replies
    1. I have hinted at such things. Maybe I need to be more blatant.

      Delete
  5. By all means, contact your state insurance commissioner. Squeaky wheel and all that. If nothing else, you can be Richard to their Richard.

    ReplyDelete
  6. As soon as you mention lawsuit (or even think about one), contact your attorney.

    ReplyDelete
    Replies
    1. Not a lawyer nor played one on TV, but I think if I had an attorney, I'd have him contact the insurers next instead of you. Prepping the battle space doncha' know.

      Delete
    2. They have paid up. Things are being resolved.

      I do think a letter to the state insurance board is in order.

      Delete
  7. They ONLY win if you give up and cave to them...

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  8. Hey, Sarge, I'm only slightly out of date here, but reading your post has triggered my insurance company vent reflex. Gawd, I hate those asshats. Like you said, they're all the same - happy as can be to take your money for decades, but the minute you make a claim, they look at you like you're asking for a freebie.

    True story - once upon a time, many, many moons ago, I worked for a legal research company. 95% of our research was done on behalf of private lawyers, but I had one file where we were acting for an insurance company. Apparently, the insureds had dared to go out for the evening, left their child with at home with a babysitter and some loss had occurred - I misremember now whether it was a fire or something else. Anyway, the asshats were looking to get out of paying on the basis that the parents were running a business out of their home (which would have voided their coverage) on the basis that ... wait for it ... they were paying a babysitter to look after their child. Can you imagine? Every time you leave your child at home with a babysitter, you have no insurance coverage?? I don't believe I had a happier day in my life then when I was able to report back that, sorry, I had completed the requested research and they could go pound sand. Okay, I might not have worded it exactly that way, but my language was a lot stronger in my head.

    ReplyDelete
    Replies
    1. No problem on the out of date comment Michelle. Comments on older posts go into moderation for a number of reasons, mostly because spammers like old posts, which I find odd to say the least, BUT it also helps me because sometimes my valued readers will chase a link to an old post and comment. I don't mind at all, letting them go to moderation first ensures I don't miss them. All that being said...

      Yes, insurance companies can be a boon or a bane. Usually it's the latter.

      Hopefully there is a special place in Hell for that insurance company you mention above.

      Sigh...

      Delete

Just be polite... that's all I ask. (For Buck)