Stupid carrier tricks has been a recurring theme at InsureBlog, proving that we are not shills for the industry that has provided us a way to make a living for a number of years. There are no perfect carriers, nor perfect industries for that matter. For the most part, the carriers get it right . . . except in areas of customer service.
And some times they do the right thing from a contractual perspective but forget that they could have made a better decision from a perspective of goodwill.
Customer service is virtually non-existent in the carrier world.
So far this year I have encountered more issues on relatively simple things that have frustrated my clients and taken up more of my time than is necessary. Here are some examples.
Carrier notifies client they have a dependent who appears to be aging off the plan. Client calls carrier asking when coverage will terminate and if their premium will change. Carrier promptly cancels coverage on ALL family members dropping the premium to $0. Client calls carrier who says "Oops!" and reinstates all family members . . . including the over-age dependent.
At this point the client calls me for assistance. I get involved and send an email followed by a call to the carrier. They (eventually) send me a form for the client to complete. It is a clean application that is to be completed (sans medical information) and the client is instructed to check the appropriate box to delete the over-age dependent.
The following month the dependent is dropped, retroactive by two months but the premium is not adjusted. We wait another month for premium accounting to catch up to the dropped dependent.
Nothing happens.
I start calling and emailing (again) the local manager about the issue.
No response.
I call and email, this time copying my client (so she knows I am working on the problem).
No response.
I call again, this time getting the manager instead of her voice mail. She apologizes and tells me I will be called within an hour with a response.
4 days pass and no word.
I call again. This time the manager sends me a terse email telling me that I am not to reveal her name to clients as a contact point for service issues.
This escalates the issue and I am finally told the problem will be resolved at the next billing cycle. If so, this means my client has overpaid some $65 per month for 4 months.
We are still waiting to see what will happen.
I am not holding my breath.
Situation number two involves a different carrier. My client (who is pregnant) wants to spin her husband and son off the current plan to a less expensive plan with the same carrier. She has been trying to accomplish this for 4 months on her own with no success.
She was not originally my client, but contacted me because I came recommended by another client. She names me her agent of record and I start to work on her problem. The carrier assures me this can be handled with a letter, requesting the dependent change.
Of course, they were only kidding.
Seems there is also a form for the client to sign, plus a form for their PCP to sign, before the change can be effected.
The change was finally effected . . . after 2 months with me working on it. Fast forward another month. The baby is born and is taken to the doc at 3 weeks of age for an initial visit.
Only problem, the baby is not on the plan. A call to the carrier from the doc's office and an hour later here is the result.
The carrier will only agree to add the baby to the plan if she signs a letter and faxes it to the carrier (from the doc's office) naming the carrier as agent of record (essentially firing me) and she gives them a credit card for $520 to cover adding the baby on for April and May.
All this for a $100 office visit.
She signs the letter and gives them a credit card.
Her next call is to me.
She wants to change to another carrier and this cannot be done quickly enough.
One more situation (even though I have quite a few I could relate).
Client applies for coverage with a high deductible ($5700). He takes Lexapro for anxiety.
The medication runs $83 per month.
They surcharged his premium by $96 per month.
Three months later, they came back and said they were only kidding. They are going to refund his $96 overcharge and lower the premium in future months.
At least, that is their story for now and they are sticking to it.
Showing posts sorted by relevance for query Stupid Carrier Tricks. Sort by date Show all posts
Showing posts sorted by relevance for query Stupid Carrier Tricks. Sort by date Show all posts
Wednesday, May 28, 2008
Sunday, April 25, 2010
Incredibly Stupid Carrier Trick? Maybe. [Updated & Bumped]
[Please scroll down for important update]
It would seem that WellPoint is eagerly looking forward to government intervention, if not outright control:
"They had no idea that WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators."
If true, this is not only incredibly short-sighted, but morally egregious.
But is this story true?
Certainly we've seen our share of Stupid Carrier Tricks, but we've also seen how the press routinely misses both the facts, and the point. There are a number of facts missing from the stories I've seen, starting with how many of these women had already been diagnosed with breast cancer before seeking coverage, and whether or not this was disclosed on their applications. It would also be helpful to know if there are other health issues involved which might have triggered rescission.
Unfortunately, a lot of this information is probably covered under HIPAA privacy rules, effectively gagging the carrier from coming to its own defense. But I didn't see anything in the news stories thus far which even hint that the reporter tried to ascertain whether or not there was more here than we're being told.
If, and it's a very big "if," WellPoint is simply casting these women off willy-nilly, then they deserve any and all consequences that come their way, and we'll proudly add this episode to our pantheon of the aforementioned Stupid Carrier Tricks.
At this point, however, that would be premature.
UPDATE: [NB: the original post was published on Friday, April 23rd] Well, that didn't take long. Turns out this is actually a "Stupid MSM Trick." Bob just alerted me to Reuter's correction, which pretty much undermines the entirety of the original story. To wit:
"Removes all references to Robin Beaton ... that the insurance company that canceled her policy was not a WellPoint subsidiary."
And:
"Technically, rescission was not the reason Reilling lost her health insurance ... Rather, it was canceled because she did not answer letters from her insurance company requesting information about her employment history."
"Technically." Kinda like saying "technically, Joe didn't rob the bank at all, but he was riding a bike." Unfortunately, the damage has been done to WellPoint's reputation (such as it might be); one can't "unring the bell."
Now, one may take issue with the idea that one's employment history should form the basis for a rescission (I certainly do), but this is a far, far cry from the sensational headline claiming that breast cancer patients are routinely kicked off their plans. But it's of a piece with these kinds of stories (as I mentioned in the original post): go with the sensational (but baseless) headline, paint a stark picture of dire straits, and hit "publish." So much for "professional journalism."
It would seem that WellPoint is eagerly looking forward to government intervention, if not outright control:
"They had no idea that WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators."
If true, this is not only incredibly short-sighted, but morally egregious.
But is this story true?
Certainly we've seen our share of Stupid Carrier Tricks, but we've also seen how the press routinely misses both the facts, and the point. There are a number of facts missing from the stories I've seen, starting with how many of these women had already been diagnosed with breast cancer before seeking coverage, and whether or not this was disclosed on their applications. It would also be helpful to know if there are other health issues involved which might have triggered rescission.
Unfortunately, a lot of this information is probably covered under HIPAA privacy rules, effectively gagging the carrier from coming to its own defense. But I didn't see anything in the news stories thus far which even hint that the reporter tried to ascertain whether or not there was more here than we're being told.
If, and it's a very big "if," WellPoint is simply casting these women off willy-nilly, then they deserve any and all consequences that come their way, and we'll proudly add this episode to our pantheon of the aforementioned Stupid Carrier Tricks.
At this point, however, that would be premature.
UPDATE: [NB: the original post was published on Friday, April 23rd] Well, that didn't take long. Turns out this is actually a "Stupid MSM Trick." Bob just alerted me to Reuter's correction, which pretty much undermines the entirety of the original story. To wit:
"Removes all references to Robin Beaton ... that the insurance company that canceled her policy was not a WellPoint subsidiary."
And:
"Technically, rescission was not the reason Reilling lost her health insurance ... Rather, it was canceled because she did not answer letters from her insurance company requesting information about her employment history."
"Technically." Kinda like saying "technically, Joe didn't rob the bank at all, but he was riding a bike." Unfortunately, the damage has been done to WellPoint's reputation (such as it might be); one can't "unring the bell."
Now, one may take issue with the idea that one's employment history should form the basis for a rescission (I certainly do), but this is a far, far cry from the sensational headline claiming that breast cancer patients are routinely kicked off their plans. But it's of a piece with these kinds of stories (as I mentioned in the original post): go with the sensational (but baseless) headline, paint a stark picture of dire straits, and hit "publish." So much for "professional journalism."
Thursday, July 19, 2007
Stupid Carrier Tricks Numbers 236, 237, 238 . . .
From time to time we showcase carriers who do stupid things such as here and here (just to list a few). Seems we have been holding back and can't take it much longer.
So here are some new ones you may know.
Stupid carrier trick #236. Blue Cross of Georgia decides to roll out a new product. Actually, it isn't new but rather imported from their parent company in California. Seems Tonik has been a hot seller in California so now it is time to introduce young Georgian's to it.
On Monday 11/20/2006 an email goes out to all brokers announcing the new product and inviting brokers to the kick off & training session.
So what's the problem?
Monday, 11/20/2006 is 3 days before Thanksgiving.
The meeting is on Tuesday 11/21/2006.
Next comes Coventry with their new individual product. They have been active in the group market for some time (operating under various names) and decided to introduce a new individual major med product to Georgia. This plan is suppose to compete handily with the much entrenched Blue Cross plans. The new Coventry plans are almost a carbon copy of the Blue plans but with more bells & whistles and a lower price. They feature quick turn around in underwriting, fast issue . . . everything you would want.
The product is approved for sale for April 15th effective dates.
The kick off meeting is never officially announced to the brokers but by way of the grapevine I find out the kick off meeting is to be held on 4/19/2007 . . . four days after the product could officially be offered.
Despite a less than auspicious start the product has been well received. In fact, too well.
They have so many applications they cannot get the policies out the door until weeks after the effective date. Letters are sent out informing a client they are approved for coverage yet when those clients call customer service it seems the enrollment department has no record of the underwriting approval issued 3 weeks earlier.
Of course since enrollment has no record of the individual, no premiums have been drafted.
Nice.
Next comes Humana. (Might as well spread it around. No need to just limit it to one carrier.)
They roll out new products in Colorado and are well received. A few months later they are introduced to AZ, IL, MI, LA, OH & TX.
So how is the announcement handled?
With a write up in a business newspaper.
And the brokers?
Not a word . . .
In case you are wondering, most carriers get 85 - 90% of their new business from brokers.
Not direct to consumer advertising.
Not from home office captive agents.
From independent brokers.
Now comes one of my favorite carriers.
No, seriously.
Last year about 60% of the business I wrote went with United HealthCare (AKA Golden Rule).
They are a great company with very good customer service, competitive products and a strong network. Their forte' is the HDHP (high deductible health plan) coupled with a seamless HSA (health savings account).
UHC owns Exante Bank. When a client buys the health insurance from UHC and opts to let Exante handle the HSA they can also let UHC draft directly from the HSA to pay providers.
The way this works is neat.
You see your doc, give them your card, and when you leave you do not pay. The doc files the claim with UHC on your behalf. About 2 weeks later the claim is processed and adjudicated by UHC and the lower, negotiated rate structure is applied. UHC then drafts your HSA and pays the provider for you.
Seamless.
This system works so well that I asked UHC if they would be willing to do the same for their other high deductible plans that are not HSA compliant. What could be more simple? The carrier already has the ability to perform a service to their client, allowing them to access providers without making a payment at time of service.
Granted, the HSA is a tax qualified plan but you can also have a non-qualified HSA. All the same benefits EXCEPT the tax favored transactions.
UHC has the system in place to draft directly from Exante Bank accounts.
UHC owns Exante Bank.
Simple request, huh?
The response is . . . "UHC will not be introducing new products with this capability".
What new product?
Same product you have now. The only change is performing a CUSTOMER SERVICE by drafting from an account OWNED BY UHC, funded by the policyholder and paying the provider directly.
No dice.
This stupid carrier trick tops my list.
At least for now . . .
So here are some new ones you may know.
Stupid carrier trick #236. Blue Cross of Georgia decides to roll out a new product. Actually, it isn't new but rather imported from their parent company in California. Seems Tonik has been a hot seller in California so now it is time to introduce young Georgian's to it.
On Monday 11/20/2006 an email goes out to all brokers announcing the new product and inviting brokers to the kick off & training session.
So what's the problem?
Monday, 11/20/2006 is 3 days before Thanksgiving.
The meeting is on Tuesday 11/21/2006.
Next comes Coventry with their new individual product. They have been active in the group market for some time (operating under various names) and decided to introduce a new individual major med product to Georgia. This plan is suppose to compete handily with the much entrenched Blue Cross plans. The new Coventry plans are almost a carbon copy of the Blue plans but with more bells & whistles and a lower price. They feature quick turn around in underwriting, fast issue . . . everything you would want.
The product is approved for sale for April 15th effective dates.
The kick off meeting is never officially announced to the brokers but by way of the grapevine I find out the kick off meeting is to be held on 4/19/2007 . . . four days after the product could officially be offered.
Despite a less than auspicious start the product has been well received. In fact, too well.
They have so many applications they cannot get the policies out the door until weeks after the effective date. Letters are sent out informing a client they are approved for coverage yet when those clients call customer service it seems the enrollment department has no record of the underwriting approval issued 3 weeks earlier.
Of course since enrollment has no record of the individual, no premiums have been drafted.
Nice.
Next comes Humana. (Might as well spread it around. No need to just limit it to one carrier.)
They roll out new products in Colorado and are well received. A few months later they are introduced to AZ, IL, MI, LA, OH & TX.
So how is the announcement handled?
With a write up in a business newspaper.
And the brokers?
Not a word . . .
In case you are wondering, most carriers get 85 - 90% of their new business from brokers.
Not direct to consumer advertising.
Not from home office captive agents.
From independent brokers.
Now comes one of my favorite carriers.
No, seriously.
Last year about 60% of the business I wrote went with United HealthCare (AKA Golden Rule).
They are a great company with very good customer service, competitive products and a strong network. Their forte' is the HDHP (high deductible health plan) coupled with a seamless HSA (health savings account).
UHC owns Exante Bank. When a client buys the health insurance from UHC and opts to let Exante handle the HSA they can also let UHC draft directly from the HSA to pay providers.
The way this works is neat.
You see your doc, give them your card, and when you leave you do not pay. The doc files the claim with UHC on your behalf. About 2 weeks later the claim is processed and adjudicated by UHC and the lower, negotiated rate structure is applied. UHC then drafts your HSA and pays the provider for you.
Seamless.
This system works so well that I asked UHC if they would be willing to do the same for their other high deductible plans that are not HSA compliant. What could be more simple? The carrier already has the ability to perform a service to their client, allowing them to access providers without making a payment at time of service.
Granted, the HSA is a tax qualified plan but you can also have a non-qualified HSA. All the same benefits EXCEPT the tax favored transactions.
UHC has the system in place to draft directly from Exante Bank accounts.
UHC owns Exante Bank.
Simple request, huh?
The response is . . . "UHC will not be introducing new products with this capability".
What new product?
Same product you have now. The only change is performing a CUSTOMER SERVICE by drafting from an account OWNED BY UHC, funded by the policyholder and paying the provider directly.
No dice.
This stupid carrier trick tops my list.
At least for now . . .
Friday, March 02, 2007
Stupid Carrier Tricks # (What, 327?)
We’re a very small agency, in a little suburb of a modest-sized Midwest town, but we do provide health insurance for those of our employees who want (and/or need) it. For a number of reasons, we’ve stayed with the same carrier for more than a few years (NTTAWWT). Of course, we’ve changed configurations over those years; the most recent was selecting a slightly higher deductible and installing an HRA (Health Reimbursement Arrangement).
Our renewal came up recently, and we had to make some choices. On the one hand, we’re not dissatisfied with the coverage and overall service of this carrier (they’re no worse – and no better – than anyone else currently in this market), but the experience I’m about to relate certainly earns it a spot in our (not so) coveted Pantheon of Stupid Carriers:
Our current plan is no longer being offered, but was a fairly typical PPO. We had coupled it with the HRA. The carrier’s automatic renewal option (the plan we’d go on by default, unless we specified otherwise, and which we’ll call Option A) is attractive: a $2,000 deductible, then 100%. Office visits are on our own nickel, but count towards the deductible (something the present plan’s co-pays don’t do). There’s still a prescription drug (rx) card, but it would be subject to that $2,000 deductible, which is “non optimal.” On the other hand, the rate is some $700/month lower than a plan with benefits similar to our present one. That would enable us to bump up the HRA numbers to offset the increased out of pocket.
But the deductible/rx tie-in is a non-starter. So I asked if they had a plan that did everything this new one would, but with an rx card that’s “turned on” from the get-go (no deductible). Turns out they do (we’ll call it Option B), so I asked for a quote on that plan.
So far, so good.
So what’s so stupid?
Well, I get all the numbers, and see something very strange : for one thing, they included the numbers for the plan we don’t like (Option A), but the premium is now some $170/month lower than what my actual renewal, which I got from the carrier in the first place, says it costs. They also included the plan we did want (Option B; same as Option A, but the rx card has no deductible), and it’s even less! Now, I’m not usually one to look a gift horse in the mouth, but this is getting stupid: why would the “better” plan (Option B) cost less than the not-as-good one (Option A)? And why are the numbers for Option A now almost $200 a month less than what we were originally told?
But wait, there’s more! I noticed on the speadsheet the carrier sent that there were TWO versions of Option A (the plan we don’t like). They were absolutely identical in benefit structure, but had two different product numbers. Plus: one was almost $200 per month more than the other.
I’ve asked, and I gotten the following response from the carrier (BTW, I’ll give them credit: at least they did respond):
“Yes, the premium is typically higher on the [“better”] plans vs. the [“not as good”] due to the up-front [no deductible] drug card. I have seen a few cases come back where that is not the case but they are pretty rare.
Additionally the [two identical but for price plans] are priced differently primarily due to experience. The [one] series did not run as well as they anticipated which has caused them to receive a higher rate than the [other] series.”
Okay then.
I do this for a living, and am reasonably adept at it, and this blows even me over.
(Warning to those who will say “Well gee, Prof, all the more reason for a national plan, so we don’t have this kind of confusion.” Oh yeah? I’ve got three words for you: I. R. S.)
Monday, September 21, 2009
Puzzling Carrier Tricks
[Welcome Industry Radar readers!]
This one has me perplexed:
[ed: Fortis is now Assurant Health]
The court obviously found Fortis at fault here, and I'm not defending them (Lord knows we've documented a few Stupid Carrier Tricks over the years). It's just that I can see someone being HIV positive and not knowing it, and then having a claim, and so on (actually, that's how Magic Johnson found out he had AIDS: it showed up in the blood test when he applied for a new life insurance policy). So the carrier gets the claim, gets the medical records, and sees one of two things:
■ No history of blood issues, let alone HIV, so obviously not pre-ex (since that requires prior knowledge), so pay the claim. Rescission is so over the top that it's just hard to imagine even home office critters being that stupid.
■ The kid knew he had HIV, files the claim, and the rest is history. This would (should) result in a denial and rescission, but then one would think that would have been upheld by the courts. So which is it?
'Tis a poser.
[Hat Tip: Holly Robinson]
UPDATE: Thanks to co-blogger Bill Halper, we learn that Fortis really was that stupid; as Bill notes, "Fortis based the recission on an incorrectly dated note in the doctor's file and declined to correct the error after repeated attempts were made to point it out."
Monday, June 09, 2008
Idiotic Carrier Tricks
[Welcome Industry Radar readers!]
So you may be asking "Henry, don't you mean Stupid Carrier Tricks?"
Sadly, no.
Regular readers may recall our piece on group insurance audits, wherein employers are required to verify that the folks on the plan are supposed to be, and that everyone that's supposed to be on the plan is [ed: clear as mud]. Early last week, one of my groups received such a request from its carrier, United Healthcare (UHC). They called me, and I helped them fill out the form. Once it was completed, they faxed it to me and I forwarded it on to our service rep. Total time involved: maybe 15 minutes, tops.
Later in the week, I received an email from the service rep: UHC wanted to know what the form was for, and why we'd sent it. Here is my response, copied directly from the "Sent" folder:
"UHC is run by idiots and/or morons. PLEASE feel free to forward that, BTW.
UHC sent this form to my client, who then complied by actually, um, completing and submitting the form as requested by the idiots/morons at UHC home office.
That help?"
My rep assured me that he'd take care of it (and I knew that he would: Don is exceptionally good at this, and really does make my job easier). He also said he'd delete my unsolicited review of UHC personnel (darn!). Well, at least I could put it away and move on.
Sure! This morning, I received a copy of a letter that UHC has sent my client, which starts with "Advanced Notification of Contract Cancellation Due To No Response And/Or Incomplete."
Let me get this straight: we get the form, we complete the form, we return the completed form, we're asked WHY we sent the completed form, and now we're facing cancellation because we didn't return the completed form?
So I called Don, and brought him up to speed. He asked me to email the letter and he'd get this resolved. So I did (and what did I title the pdf file? This: [client]_uhc_morons.pdf).
But you said tricks, Henry. Is there more?
Oh, indeed yes, dear reader:
Sometime around the last week of May, the owner of another of my groups called to tell me he would be turning 65 in June, and needed some advice. His spouse has some health issues, and we really need to keep her on the group, which we have with Anthem. He's continuing to work, so that's not a big problem. I explained to him that, since it's under 20 employees, Medicare is primary and so the group essentially becomes a Medicare Supplement plan.
"That's nice, Henry," he said, "but what's it gonna cost me?" Well, let's look at the renewal, which should have the MedSup rates in it.
Except it doesn't. So I request these rates. Three times in the past two and a half weeks. And until just a few minutes ago, I couldn't get them. The penultimate email read:
"I sincerely apologize for the delay in getting the Medicare rates to you. Enrollment/Billing was not able to pull them for me so I have to go back to underwriting to see if they can provide. I am hoping for a response from the underwriter today. I will let you know as soon as I get something back from her."
I received that about an hour ago, and replied:
"I guess it's comforting to know that UHC isn't the only company run by incomptent morons and idiots. Just not VERY comforting."
Five minutes ago (while I was composing this post), I received this wonderful news:
"The member that is turning 65 would pay the same rate as the active members. The renewal rates are based on the current census and since this member was not on Medicare at the time of the renewal, the Medicare rates will not apply until their next renewal."
Anyone else see the problem with that?
I'll keep you posted.
Monday, April 19, 2010
Laudable Carrier Tricks: College Edition [UPDATED]
While I have my issues with the whole idea that 26 year olds should be considered "dependents" on their parents' health insurance, it is the law (for now).
Or rather, it will be the law, come late September. For now, when college students "age off" ther parents' plans, they're on their own (which is perhaps a valuable lesson in personal responsibility). Nevertheless, soon carriers will be forced to postpone that separation.
United HealthCare (while the target of several episodes of Stupid Carrier Tricks) has pre-emptively decided to implement that postponement effective immediately. According to an email from the carrier:
"We want students to graduate into a secure future, not the ranks of the uninsured. We saw an issue with this possible gap in coverage and are the first health insurance company taking action ahead of the new requirements."
Of course, the premise - that 22- and 23-year olds aren't capable of purchasing their own insurance - is quite flawed. But the sentiment is compelling, and so UHC "will work with ... clients that wish to extend the health coverage that graduating college students currently have under their parents' plans."
Partial kudos to UHC.
UPDATE: My inner cynic finally determined why I found UHC's concern about young adults not joining "the ranks of the uninsured" so disingenuous. Healthy young people are essentially "free money" to insurers, producing few claims. When a 22- or 23-year old ages off his/her parents' plan, the carrier loses that money; since so many young people choose to remain uninsured, carriers lose revenue. By pre-emptively implementing the new regs, a carrier mitigates that loss.
Yes, dependent coverage has historically been less expensive than a stand-alone plan (although that will likely change now), but "half a loaf..." Can't say I blame them, either.
Or rather, it will be the law, come late September. For now, when college students "age off" ther parents' plans, they're on their own (which is perhaps a valuable lesson in personal responsibility). Nevertheless, soon carriers will be forced to postpone that separation.
United HealthCare (while the target of several episodes of Stupid Carrier Tricks) has pre-emptively decided to implement that postponement effective immediately. According to an email from the carrier:
"We want students to graduate into a secure future, not the ranks of the uninsured. We saw an issue with this possible gap in coverage and are the first health insurance company taking action ahead of the new requirements."
Of course, the premise - that 22- and 23-year olds aren't capable of purchasing their own insurance - is quite flawed. But the sentiment is compelling, and so UHC "will work with ... clients that wish to extend the health coverage that graduating college students currently have under their parents' plans."
Partial kudos to UHC.
UPDATE: My inner cynic finally determined why I found UHC's concern about young adults not joining "the ranks of the uninsured" so disingenuous. Healthy young people are essentially "free money" to insurers, producing few claims. When a 22- or 23-year old ages off his/her parents' plan, the carrier loses that money; since so many young people choose to remain uninsured, carriers lose revenue. By pre-emptively implementing the new regs, a carrier mitigates that loss.
Yes, dependent coverage has historically been less expensive than a stand-alone plan (although that will likely change now), but "half a loaf..." Can't say I blame them, either.
Tuesday, October 31, 2006
Stupid Carrier Tricks: Umpteenth Edition
Sometimes, it seems as if we could populate this blog exclusively with stories of the dumb things insurance companies do. Of course, we’d have to change its name, but still.
Our latest installment in this “series” comes from Anthem Blue Cross/Shield, which has notified those of us who sell their group plans of their newest requirement: when submitting a Request for Proposal, we must now include the Federal ID number (EIN) of the group in question. This is idiotic.
Why, you may ask?
Well for a number of reasons:
First, employers are no less subject to identity theft than indiviuals, but Anthem’s not requiring us to submit those when getting a quote [ed: Hush! Don’t give ‘em any ideas!]. (And, yes, most of us do quote individual products on our own PC’s, but not all agents have this ability)
Second, and IMHO, more egregious, is that this effectively shuts out competition. How so? Simple: if one is not the incumbent agent, how likely is it that a prospect (who may be a referral, or a cold call, or a friend of a friend) will be likely to part with that information simply to obtain a quote? More likely, they’ll just call their existing agent and avoid the bother.
Third, what possible reason would a carrier have to require this information simply to provide a quote? It’s just one more example of heavy handed tactics that occur when a carrier dominates a given market.
Stupid, stupid, stupid.
(There, I feel better already!)
UPDATE: It gets dumber [ed: this is possible?]. Since there's no way for Anthem to verify the abovementioned EIN, why wouldn't agents simply make one up for quoting purposes? What's the worst that could happen? "Here's a new, sold case. Oh, I accidentally included an incorrect EIN with the quote request? Gee, I'm sorry."
Our latest installment in this “series” comes from Anthem Blue Cross/Shield, which has notified those of us who sell their group plans of their newest requirement: when submitting a Request for Proposal, we must now include the Federal ID number (EIN) of the group in question. This is idiotic.
Why, you may ask?
Well for a number of reasons:
First, employers are no less subject to identity theft than indiviuals, but Anthem’s not requiring us to submit those when getting a quote [ed: Hush! Don’t give ‘em any ideas!]. (And, yes, most of us do quote individual products on our own PC’s, but not all agents have this ability)
Second, and IMHO, more egregious, is that this effectively shuts out competition. How so? Simple: if one is not the incumbent agent, how likely is it that a prospect (who may be a referral, or a cold call, or a friend of a friend) will be likely to part with that information simply to obtain a quote? More likely, they’ll just call their existing agent and avoid the bother.
Third, what possible reason would a carrier have to require this information simply to provide a quote? It’s just one more example of heavy handed tactics that occur when a carrier dominates a given market.
Stupid, stupid, stupid.
(There, I feel better already!)
UPDATE: It gets dumber [ed: this is possible?]. Since there's no way for Anthem to verify the abovementioned EIN, why wouldn't agents simply make one up for quoting purposes? What's the worst that could happen? "Here's a new, sold case. Oh, I accidentally included an incorrect EIN with the quote request? Gee, I'm sorry."
Thursday, March 22, 2007
Stupid Admin Tricks
Well, why not? We've had Stupid Carrier and Stupid Client tricks, and now we have a new category.
So what brings this on?
One of my groups, which has been a client for almost 20 years, recently agreed with me that they should change from their generic co-pay plan to a high deductible plan coupled with an HRA (Health Reimbursement Arrangement). The primary benefits of this move were two-fold: the employer saved a great deal on the premium (one of those unfortunately-rare cases where the price differential was substantial), and could afford to generously fund the reimbursement account.
Regular IB readers know that we almost always redact the names of carriers when we discuss them. This is not so much for purposes of liability as it is that most carriers do stupid things, so that it is not really useful to identify which one in any given scenario. But what happened in this instance was so egregious that I feel compelled to actually name the entity involved.
The carrier we're using in this case owns an HRA administrative company, called Definity. Their offer is simple and attractive: if you write your case with the parent company, Definity will set up and administer your HRA for free. This can be significant: set-up fees alone can run into the hundreds of dollars, and on-going administrative services into the thousands.
Still, it is said that free advice is worth what you pay for it, and so appears to be the case with free HRA administrative services.
Of a Monday, I called the number I had, to get the ball rolling (arrange for paperwork and instructions to be sent to the client). But when I called the number I had been given (by the carrier), the "gentleman" who answered refused to identify either himself or his company. That was odd, so I asked if I had gotten the right number, was this Definity? Instead of answering this reasonably straight-forward question, he asked if I was a "member." Hunh?
So I asked again, had I connected with Definity. He replied that he couldn't tell me that (would he have had to kill me?) unless I confirmed that I was a member. I pointed out that he was being moronic, that all I wanted to know was whether or not I had dialed the correct number, and if this was indeed Definity. He refused to budge, so I asked for his supervisor. I was told that "Dan" was not going to be available to me, and I observed that this was idiotic. The "gentleman" objected to this characterization, and warned me that if I persisted, he would hang up. I replied "Too late!" and disconnected. Redialing the number, I was connected with a different person, who was apparently empowered to divulge the fact that this was, in fact, Definity, but that the number I had been given was for claims, not "sales," and that she couldn't connect me to that one.
At this point, it occurred to me that I had learned something quite valuable: if these folks were this incompetent when I'm trying to get a relatively simple plan set up, I can only imagine how poorly they would have managed the arrangement itself. Thankfully, I was able to save my client from such a fate by referring him to a local admin who charges a reasonable fee for his services. It's true: Definity's plan was free but, at that, it would have been far too expensive for my tastes.
Thursday, August 13, 2009
Weird Carrier Tricks [UPDATED & BUMPED]
[Please scroll down for update]
This one would initially seem to fall under our Stupid Carrier Tricks category, but it also seems to have a "happy ending:"
Hunh?
Apparently, Heather Toplak is a 35 year old breast cancer survivor, who needs annual blood screenings to determine if she's still in remission. Such tests are generally considered "standard of care," meaning that they're usually covered expenses, unlike much more expensive scans. This can save the insurer (and thus, its policyholders) a lot of money, which would seem to be a good thing.
During her battle with the cancer, Anthem apparently had no qualms about paying for various treatments and procedures [ed: Hey, aren't they supposed to fight these types of claim tooth and nail, and then cancel the offending insured's coverage? Looks like someone didn't get the memo!]. The follow-up blood test was denied as "not medically necessary," and recommended that she instead undergo a (much more expensive) Pet Scan. One presumes, given her condition, that she would have already met most (if not all) of her own out-of-pocket maximum, meaning that Anthem would have footed most or all of that bill.
Now, the twist: Mrs Toplak contacted her local TV-news troubleshooter, who in turn contacted the insurer. Anthem has reversed its decision, and "has agreed to pay for the [blood test]. Not only that, they are changing their policy on paying for these blood tests going forward."
Kudos!
The story still left a few unanswered questions:
■ Why was an Arizona woman covered by Anthem (since that state is served by BCBS of Arizona)?
■ What type of policy did she have, a co-pay plan or an HSA?
That second question is important because it's generally presumed that folks with HSA plans are more attuned to these issues.
I've emailed the reporter for clarification. So far, I haven't heard back. We'll let you know if and when we do.
[Hat Tip: FoIB Rick B]
UPDATE: In the comments, reader John H tells us that Mrs Toplak is most likely covered under the "Bluecard" program, which enables folks who live in states served by other "Blues" to have essentially seamless cover.
And we've heard from Carey Peña, the reporter on whose work we based this post. She tells us that she appreciates our "posting the story and hope that it helps advance the conversation."
In response to our question regarding the type of coverage involved, she writes:
"I’m not at liberty to answer your questions due to the privacy that I extend to my interview subjects. However I am more than happy to forward your link and request to Mrs. Toplak and if she wants, she can contact you directly with additional information."
That's an entirely reasonable response; we'll let you know if we hear from Mrs Toplak.
Tuesday, June 23, 2015
Generous Carrier Tricks
Our on-going Stupid Carrier Tricks series is generally over-represented, so it's nice to be able to add one on the positive side. Medblogger Lisa Emrich daily chronicles her thoughts and strategies as she battles MS; she also reports significant events on Facebook, where she recently posted this:
"Some readers doubted my description of an insurance company who pays much more than hospital charges for an infusion. See details from the EOB."
Turns out, her Grandfathered health insurance plan (from Carefirst BCBS) allows for very generous benefits, especially when it comes to treating her MS.
How generous, you ask?
This generous:
"Some readers doubted my description of an insurance company who pays much more than hospital charges for an infusion. See details from the EOB."
Turns out, her Grandfathered health insurance plan (from Carefirst BCBS) allows for very generous benefits, especially when it comes to treating her MS.
How generous, you ask?
This generous:
That's right, they actually allow a greater amount than what her provider ended up charging her, and this was in turn reflected in her balance due. And, of course, the amount she pays in co-insurance helps reduce the balance for the rest of the year.
Reason I mentioned her Grandfathered status is that this plays a role in the overall scheme of things. Lisa tells me that "I absolutely appreciate the 10% coinsurance which is why I've kept this grandfathered plan. After Carefirst processes the 2nd infusion (in June), I will have fulfilled my max OOP (for medical) for the year." Nice.
Bottom line: it's nice to know that some carriers really do try to help out their insureds whenever possible. Chalk one up for the good guys.
Tuesday, October 20, 2009
Stupid Consumer Tricks
Regular readers are familiar with our "Stupid Carrier Tricks" series; a lesser-known version recounts those all-too-infrequent occasions where a carrier "gets it right." I'm very pleased to say that this is one of the latter.
In an email I received yesterday, Aetna says that it's finally had enough of agents and employers taking advantage of the low rates afforded to and by high deductible health plans. The point of these plans is to encourage and empower consumer participation in health care decisions, making more economically and medically efficient choices regarding health care. The problem is that some folks are "gaming" the system by wrapping these plans with substantial first-dollar benefits, thereby defeating the purpose, and diluting the net gain.
Okay, let's try that in English, instead of insure-speak:
By choosing a high deductible, "no frills" health insurance plan, consumers (whether that's an employer group or folks on individual policies) enjoy lower premiums. That's because the insurer doesn't have to adjudicate a lot of small, routine claims and can thus save money on administrative costs. It also encourages consumers to make conscious decisions about health care, because they now have "skin in the game." These premium savings help the consumer more easily absorb the occasional catastrophic claim, because they've sent less money to the insurance company.
A classic "win-win" scenario.
Except when it isn't:
Apparently, a number of employer (or group) plans have been providing first dollar coverage to their covered employees. So that if, for example, the plan has a $1500 deductible, the employer is ponying up $500 or $1000 of that on the employees' behalf (or reimbursing them when claims are made). Thus, the employee has little or no incentive to make careful health care decisions, since the lower-cost high deductible plan ends up working pretty much like the high-cost co-pay plan it replaced.
If this sounds like an HRA (Health Reimbursement Arrangement), you're not far off.
Aetna finally figured out that a lot of their insured groups were doing just that, and using the savings to subsidize the higher out-of-pocket, thereby defeating whatever cost savings the plan might have engendered. And they're putting the kibosh on it:
"In recent months, Aetna has seen an increase in "underlying" or "wrap-around" plans that have not been disclosed prior to premium quoting.
We define an underlying or wrap around plan as any plan that either partially or completely subsidizes any member cost sharing outside of a federally-qualified Health Reimbursement Account (HRA) or Health Savings Account (HSA). Member cost sharing includes but is not limited to co-pays, deductibles and/or member coinsurance balances. (Employee funded Flexible Spending Accounts are not considered underlying plans) .*" [emphasis in original]
The offending employers have been kicking in 50% - or more! - of the underlying deductible, which has resulted in adverse selection, reduced health care savings, and increased "trend" (one factor in rate increases). This in turn has led to tainted risk pools and reduced end-user (consumer) savings, and presumably higher than expected rate increases at renewal time.
So what, you may ask, do they propose to do about this?
Going forward, they'll be requiring employers to "attest that no such underlying plans are present and that they are not funding the deductible in excess of 50% annually whether through an HRA or HSA." It's a separate form that must accompany all applicable new group applications. The form will essentially require the employer to promise not to pay more than 50% of the plan deductible. And this new rule has teeth: if the employer lies on that form and ends up subsidizing in excess of that 50% cap, it faces "rate increases, non-renewal, or termination."
Which, of course, begs the question: how would they know?
And that's a great question. I called Aetna this morning, and was told that, much like Blanche DuBois, they'll be relying on the employers' honesty. In other words, that they'll drop a dime on themselves. Uh-hunh.
While it would be easy to dismiss this out of hand, I must admit that I don't know how they'd track this, either. One would think that patterns could be seen in offending groups' claims, but perhaps that's not yet feasible. It's a shame, really, because it unfairly affects those groups who do choose to play by the rules.
In an email I received yesterday, Aetna says that it's finally had enough of agents and employers taking advantage of the low rates afforded to and by high deductible health plans. The point of these plans is to encourage and empower consumer participation in health care decisions, making more economically and medically efficient choices regarding health care. The problem is that some folks are "gaming" the system by wrapping these plans with substantial first-dollar benefits, thereby defeating the purpose, and diluting the net gain.
Okay, let's try that in English, instead of insure-speak:
By choosing a high deductible, "no frills" health insurance plan, consumers (whether that's an employer group or folks on individual policies) enjoy lower premiums. That's because the insurer doesn't have to adjudicate a lot of small, routine claims and can thus save money on administrative costs. It also encourages consumers to make conscious decisions about health care, because they now have "skin in the game." These premium savings help the consumer more easily absorb the occasional catastrophic claim, because they've sent less money to the insurance company.
A classic "win-win" scenario.
Except when it isn't:
Apparently, a number of employer (or group) plans have been providing first dollar coverage to their covered employees. So that if, for example, the plan has a $1500 deductible, the employer is ponying up $500 or $1000 of that on the employees' behalf (or reimbursing them when claims are made). Thus, the employee has little or no incentive to make careful health care decisions, since the lower-cost high deductible plan ends up working pretty much like the high-cost co-pay plan it replaced.
If this sounds like an HRA (Health Reimbursement Arrangement), you're not far off.
Aetna finally figured out that a lot of their insured groups were doing just that, and using the savings to subsidize the higher out-of-pocket, thereby defeating whatever cost savings the plan might have engendered. And they're putting the kibosh on it:
"In recent months, Aetna has seen an increase in "underlying" or "wrap-around" plans that have not been disclosed prior to premium quoting.
We define an underlying or wrap around plan as any plan that either partially or completely subsidizes any member cost sharing outside of a federally-qualified Health Reimbursement Account (HRA) or Health Savings Account (HSA). Member cost sharing includes but is not limited to co-pays, deductibles and/or member coinsurance balances. (Employee funded Flexible Spending Accounts are not considered underlying plans) .*" [emphasis in original]
The offending employers have been kicking in 50% - or more! - of the underlying deductible, which has resulted in adverse selection, reduced health care savings, and increased "trend" (one factor in rate increases). This in turn has led to tainted risk pools and reduced end-user (consumer) savings, and presumably higher than expected rate increases at renewal time.
So what, you may ask, do they propose to do about this?
Going forward, they'll be requiring employers to "attest that no such underlying plans are present and that they are not funding the deductible in excess of 50% annually whether through an HRA or HSA." It's a separate form that must accompany all applicable new group applications. The form will essentially require the employer to promise not to pay more than 50% of the plan deductible. And this new rule has teeth: if the employer lies on that form and ends up subsidizing in excess of that 50% cap, it faces "rate increases, non-renewal, or termination."
Which, of course, begs the question: how would they know?
And that's a great question. I called Aetna this morning, and was told that, much like Blanche DuBois, they'll be relying on the employers' honesty. In other words, that they'll drop a dime on themselves. Uh-hunh.
While it would be easy to dismiss this out of hand, I must admit that I don't know how they'd track this, either. One would think that patterns could be seen in offending groups' claims, but perhaps that's not yet feasible. It's a shame, really, because it unfairly affects those groups who do choose to play by the rules.
Tuesday, December 11, 2007
Stupid Carrier Tricks #143
Of all the types of claims we see in the life and health business, a natural death claim on a 20 year old policy would seem to be the least likely to be a problem.
After all, such a policy is well past the contestable period, and there's no foul play (my client died of cancer). It's tailor-made for prompt settlement.
Unless, apparently, the carrier's Time Insurance (aka Hartford Life).
The facts are pretty straightforward: we wrote a universal life insurance policy on a gentleman in 1988, and he died of cancer on October 28, 2007. I contacted the carrier immediately, and they responded to the request for paperwork quickly.
And that was the last thing they did "quickly."
I met with the widow a week or so later, and we submitted the completed paperwork on November 9th. Then we waited.
And waited.
Eventually, I called Kelly Wanovich, the "claim analyst" who had initially responded to our request on October 31st. He told me that it can take up to 10 business days for a claim to be processed and paid. It's now over a month since we filed the claim (for those keeping track at home, that's 20 business days, if we presume that the obviously overworked staff at Time Insurance took off Thanksgiving and "Black Friday"), and still no check. I did receive a call late last week indicating that it was being "processed" and would soon be on its way, but "the check is in the mail" doesn't put food on the widow's table, or make the mortgage payment for a roof over her head.
I even emailed Mr Wanovich last Friday:
"Got your voice mail, and was pleased to hear that the check is (finally) on its way.
I still don't understand why it's taken almost a month (including some 20 business days) for this to happen. I'd like to be able to explain this to [redacted], his widow, as well. Can you help with that?"
Of course, I have yet to receive a response.
There is simply no excuse for such an egregious abuse of the claims process. Trust me, if my client had been a day late with his premium payment, he would have quickly received a "reminder" notice from the carrier. But when it's time to pay, where is that state-of-the-art system to be found? Certainly not in the Claims Department.
It's one thing when there's a legitimate question about a claim; after all, we all suffer when carriers are defrauded. But it is quite another to deliberately withhold money on a straightforward, no-brainer claim such as this.
Unless, of course, you're a carrier, and the term "no brain" fits a little too well.
UPDATE 12/12/07: O Frabjous Day! The death claim check arrived this afternoon, a month after the claim was submitted. On the one hand, this is terrific news for the widow. On the other, it does not mitigate or negate the agregiously long time it took for this to happen.
Monday, February 02, 2009
Monday, March 21, 2011
The Good of the Many, The Needs of the Few
Over the years, we've posted numerous entries to our "Stupid Carrier Tricks" series. The common theme is that insurance companies, like any other corporation, have no "ethics." And yet, carriers are made up of people, and people do (or don't).
The other day, I attended a CE (Continuing Education) class on Ethics. My fellow participants couldn't understand why I was giggling about an "Ethics" course given - for free! - to agents who'd received a "goody bag" full of tschochkes (chip clips, staplers, etc). Often there's an obvious "line in the sand" across which we dare not step.
Sometimes, though, it's not so simple.
I recently received an email from the Immune Deficiency Foundation (IDF) about Highmark Blue Cross' newest policy regarding those with immune system disorders. This is serious stuff: folks who suffer from these conditions lack the ability to fight off even simple infections. The cost to treat it can be enormous; as regular readers know, prescription costs are a major driver of insurance rates.
And yet.
The people who have these conditions face potentially life-threatening results if their meds are changed or excluded.
Highmark Blue Cross and Blue Shield recently changed the way they cover medications for this fairly exclusive group. And thus begins our saga. After receiving the IDF email, I replied that I was, in fact, interested in learning more. But I also know, from previous experience, that there are usually (at least) two sides to these kinds of stories, and so I reached out to Highmark, as well.
After speaking with the Highmark rep, and reading his follow-up email, I connected with Larry La Motte, the IDF's Director of Public Policy. Larry very graciously gave me about an hour of his time, and I came away from the experience with quite mixed feelings. What struck me deeply is that, from my perspective, both sides are "right." That is, there's no obvious "bad guy" here. The good news, such as it is, is that the folks from IDF (and other such groups) have obviously swayed the debate: it appears that Highmark's initial position has softened.
So what's the story?
According to Highmark's Aaron Billger, there are about 350 Highmark insureds potentially affected by this policy. To put that into perspective, the carrier insures over 4 million people. By any objective measure, 350 out of 4.something million is less than a rounding error. Of course, the lives of these 350 people are no less (and no more) important than the other 4.something million, but the cost of their meds affect every single one of them. What to do?
Well, one way to handle this would be to exclude all such treatments. That seems draconian (although not something I'd put past "Sir" Donald Berwick), but continuing to pay for all manner of treatment isn't fiscally sound, either. What Highmark plans to do is to change the way it covers these treatments, both for those currently covered and those who come on board beginning next month.
The aforementioned IDF is, understandably, displeased with what they see as a potential death sentence for those insureds affected by the new plan design. Briefly, it is their belief that the status quo ante was sufficient and justifiable, and they'd prefer that no such changes be implemented. The carrier demurs, and thus the impasse.
According to the IDF's email, there were 4 major sticking points:
"IDF has asked that any Highmark policy should:
• Not determine the specific IgG therapy a patient must use
• Ensure that patients already stabilized on an IgG therapy not be switched to another therapy without medical cause
• Allow physicians an opportunity to prescribe an alternative if they determine it is in the best interest of the patient
• Better inform patients and physicians about its policy plans and gain direct feedback on their recommendations."
It seems to me that the first one is unreasonable: if the carrier is expected to pay for something, then it seems to me that they get to make that call (within reason). The second and third, however, do seem reasonable (the fourth is bluster).
What's heartening is that, in the Mr Billger's email, "a large majority [of the affected insureds] are already on our preferred IG product. They will not be directly impacted by this policy." He also reported that the new policy will now "provide continued coverage for members currently using non-preferred IG products, when clinically appropriate, with no disruption." And finally, the new "policy will cover a non-preferred IG product for someone new to therapy when the prescribing physician documents ... why the preferred product is not suitable."
Seems to me that this has been resolved in a manner that's fair to all involved, and causes the least disruption and potential danger to the affected members. Still, it offers a valuable lesson in how carriers can work with special interest/needs groups to find common cause and solutions.
Kudos to Highmark and the Immune Deficiency Foundation (as well as the other groups involved) for defusing a potentially volatile situation and working towards a resolution that's in everyone's best interest.
The other day, I attended a CE (Continuing Education) class on Ethics. My fellow participants couldn't understand why I was giggling about an "Ethics" course given - for free! - to agents who'd received a "goody bag" full of tschochkes (chip clips, staplers, etc). Often there's an obvious "line in the sand" across which we dare not step.
Sometimes, though, it's not so simple.
I recently received an email from the Immune Deficiency Foundation (IDF) about Highmark Blue Cross' newest policy regarding those with immune system disorders. This is serious stuff: folks who suffer from these conditions lack the ability to fight off even simple infections. The cost to treat it can be enormous; as regular readers know, prescription costs are a major driver of insurance rates.
And yet.
The people who have these conditions face potentially life-threatening results if their meds are changed or excluded.
Highmark Blue Cross and Blue Shield recently changed the way they cover medications for this fairly exclusive group. And thus begins our saga. After receiving the IDF email, I replied that I was, in fact, interested in learning more. But I also know, from previous experience, that there are usually (at least) two sides to these kinds of stories, and so I reached out to Highmark, as well.
After speaking with the Highmark rep, and reading his follow-up email, I connected with Larry La Motte, the IDF's Director of Public Policy. Larry very graciously gave me about an hour of his time, and I came away from the experience with quite mixed feelings. What struck me deeply is that, from my perspective, both sides are "right." That is, there's no obvious "bad guy" here. The good news, such as it is, is that the folks from IDF (and other such groups) have obviously swayed the debate: it appears that Highmark's initial position has softened.
So what's the story?
According to Highmark's Aaron Billger, there are about 350 Highmark insureds potentially affected by this policy. To put that into perspective, the carrier insures over 4 million people. By any objective measure, 350 out of 4.something million is less than a rounding error. Of course, the lives of these 350 people are no less (and no more) important than the other 4.something million, but the cost of their meds affect every single one of them. What to do?
Well, one way to handle this would be to exclude all such treatments. That seems draconian (although not something I'd put past "Sir" Donald Berwick), but continuing to pay for all manner of treatment isn't fiscally sound, either. What Highmark plans to do is to change the way it covers these treatments, both for those currently covered and those who come on board beginning next month.
The aforementioned IDF is, understandably, displeased with what they see as a potential death sentence for those insureds affected by the new plan design. Briefly, it is their belief that the status quo ante was sufficient and justifiable, and they'd prefer that no such changes be implemented. The carrier demurs, and thus the impasse.
According to the IDF's email, there were 4 major sticking points:
"IDF has asked that any Highmark policy should:
• Not determine the specific IgG therapy a patient must use
• Ensure that patients already stabilized on an IgG therapy not be switched to another therapy without medical cause
• Allow physicians an opportunity to prescribe an alternative if they determine it is in the best interest of the patient
• Better inform patients and physicians about its policy plans and gain direct feedback on their recommendations."
It seems to me that the first one is unreasonable: if the carrier is expected to pay for something, then it seems to me that they get to make that call (within reason). The second and third, however, do seem reasonable (the fourth is bluster).
What's heartening is that, in the Mr Billger's email, "a large majority [of the affected insureds] are already on our preferred IG product. They will not be directly impacted by this policy." He also reported that the new policy will now "provide continued coverage for members currently using non-preferred IG products, when clinically appropriate, with no disruption." And finally, the new "policy will cover a non-preferred IG product for someone new to therapy when the prescribing physician documents ... why the preferred product is not suitable."
Seems to me that this has been resolved in a manner that's fair to all involved, and causes the least disruption and potential danger to the affected members. Still, it offers a valuable lesson in how carriers can work with special interest/needs groups to find common cause and solutions.
Kudos to Highmark and the Immune Deficiency Foundation (as well as the other groups involved) for defusing a potentially volatile situation and working towards a resolution that's in everyone's best interest.
Monday, August 27, 2007
Insurers Behaving (Very) Badly
I'd originally planned to post this as another in our "Stupid Carrier Tricks" series, but this strikes me as so egregious that the term "tricks" doesn't do it justice.
I still believe that most carriers follow the letter, if not the spirit, of the law when investigating and adjudicating claims. But I may have to rethink that position in light of this:
Turns out, the Pitts' were involved in an automobile accident, in which they were not at fault. They maxed out the at-fault driver's insurance, and apparently filed under their own underinsured motorists cover. Their own carrier, Progressive Northern Insurance Company (which, according to A M Best, is a subsidiary of "the" Progressive insurance folks) instigated this outrageous and morally indefensible action against their own insureds.
Words fail me.
Well, words appropriate for this family-friendly blog.
What these "investigators" were hoping to learn at a church-run encounter group escapes me, but they must have figured that their own ends justified this dastardly means.
It seems to me that Progressive owes the Pitts a public apology, and swift, unquestioning payment of their claim.
It's the very least they can do.
(H/T to Bill Montgomery, CIC)
Monday, February 16, 2015
Stupid Claims Rep Tricks
Over the years, our Stupid Carrier Tricks series has garnered quite a few eyeballs. The carriers, though, rely on individuals to carry out the work; in the P&C area, claims are generally handled by claims representatives (aka "adjusters"). Law-blogger (and longtime FoIB) Eric Turkewitz has a fascinating, frustrating post up about a weaselly Allstate Rep with a snarky attitude and faulty brain filter:
"A snarky email from an Allstate adjuster may cost the company $900,000 ... especially since the defendant had a problem with its expert."
Eric makes often complex legal issues easily understood, and you can't help but smile at his take on the adjuster.
Recommended.
"A snarky email from an Allstate adjuster may cost the company $900,000 ... especially since the defendant had a problem with its expert."
Eric makes often complex legal issues easily understood, and you can't help but smile at his take on the adjuster.
Recommended.
Tuesday, May 22, 2007
Enrolling the Dead
Here at InsureBlog we try to put a positive spin on things as much as possible but have not shied away from exposing the dirty side of our industry. Most of the time the dark side has to do with carriers (Stupid Carrier Tricks) or providers (Stupid Doctor Tricks) but we have also been quick to chastise agents that have crossed the line.
It seems that some agents working in the 65+ market have found "creative" ways of generating sales . . . and commissions.
In documents provided to congress evidence is clearly present that suggests that insurance salesmen in 39 U.S. states used illegal or unethical tactics in order to get a signature on the dotted line. Furthermore they were willing to enroll the dead,mentally incompetent, use stolen private information attained from federal records and even impersonate Medicare representatives, to win over another unsuspecting consumer.
As if that were not enough, along comes this little gem.
It is estimated that 1 out of 5 Americans who are enrolled in Medicare are on one of the Medicare Advantage plans, and according to some experts these plans are costing the government more money than are the traditional Medicare plans.
Presumably the dead enrollees are not contributing to this shortfall . . .
It seems that some agents working in the 65+ market have found "creative" ways of generating sales . . . and commissions.
In documents provided to congress evidence is clearly present that suggests that insurance salesmen in 39 U.S. states used illegal or unethical tactics in order to get a signature on the dotted line. Furthermore they were willing to enroll the dead,mentally incompetent, use stolen private information attained from federal records and even impersonate Medicare representatives, to win over another unsuspecting consumer.
As if that were not enough, along comes this little gem.
It is estimated that 1 out of 5 Americans who are enrolled in Medicare are on one of the Medicare Advantage plans, and according to some experts these plans are costing the government more money than are the traditional Medicare plans.
Presumably the dead enrollees are not contributing to this shortfall . . .
Wednesday, October 15, 2008
Stupid Carrier Tricks #148
Most of this much loved (or reviled, depending on your perspective) series has been vents about carriers doing incredibly stupid things to alienate consumers. But just so you know, they sometimes do dumb things to create distrust among the agents who send them business.
I spent most of the morning dealing with Aetna over commission issues. A recent bank change required me to complete new paper work for direct deposit. I sent them the proper form and assumed everything was fine.
What a silly thing that was.
Today I get an email from the "commission lady" informing me they have the wrong FEIN for my agency. In fact, they have two different ones on file, neither of which are correct.
I sent them copies of tax documents filed with the state, but that was not good enough. Neither was a coupon used for federal tax payments.
The next remark sent me over the top.
Unless I can provide them with proof from the Georgia Department of Insurance of my correct FEIN, they will cease paying commissions and report me to the IRS for reporting a false FEIN to a carrier.
Now isn't that special?
I spent most of the morning dealing with Aetna over commission issues. A recent bank change required me to complete new paper work for direct deposit. I sent them the proper form and assumed everything was fine.
What a silly thing that was.
Today I get an email from the "commission lady" informing me they have the wrong FEIN for my agency. In fact, they have two different ones on file, neither of which are correct.
I sent them copies of tax documents filed with the state, but that was not good enough. Neither was a coupon used for federal tax payments.
The next remark sent me over the top.
Unless I can provide them with proof from the Georgia Department of Insurance of my correct FEIN, they will cease paying commissions and report me to the IRS for reporting a false FEIN to a carrier.
Now isn't that special?
Friday, April 21, 2006
Stupid Carrier Tricks...
So Medical Mutual of Ohio (a fairly large, state-wide carrier) just bought Summit Insurance (a much smaller one). The deal’s been in the works for at least six months, and was finalized and announced a month or so ago.
So far, so good.
The actual transfer of business is set to take effect on May 1, so the carriers scheduled a series of meetings to familiarize brokers (agents) with what the sale means, what changes we can expect, and to answer any questions we might have.
Yesterday, I attended the last of 4 locally scheduled broker meetings:
First, the representative from Summit got up and spoke for about 45 minutes (which was approximately 35 minutes longer than was necessary). One could tell that the gentleman was not pleased to see his beloved company fade into oblivion, but we got that message pretty early on. He fielded a few questions, answering some, and passing others to the MMO person.
When Mr Summit was finished, he turned the meeting over to Ms MMO. She also spoke for a bit longer than was necessary.
There were, of course, a number of important (and urgent) items, but the two “take away” pieces were:
■ Although most maintenance prescriptions will (theoretically) transfer over from Summit to MMO, controlled substances and compounded meds will not; they will have to be re-prescribed. While this may not sound like a big deal, it certainly could be: physicians are restricted in how many of these scrips they can write for a given individual. Ooops.
■ Any procedures pre-authorized by Summit, which are scheduled for May 1 and later, must be re-authorized (by MMO). Granted, this makes sense from a claims standpoint, but announcing it only 10 days in advance is, well, stupid. How many such procedures will now have to be re-scheduled, as well?
The icing on this particular cake, however, took place near the end of the meeting. Our presenters had been unable to answer about half of our questions. So, I raised my hand:
“I have a more big picture question. Y’all have been working on this for over 6 months, and yet you’ve been unable to answer a lot of the questions we’ve asked today. And, this is the fourth such meeting you’ve held. We have no idea what questions were raised, and left unanswered, in the other three meetings. So, will there be an email or fax that addresses all these questions for us?”
Ms MMO replied that “that’d be a great idea. But we haven’t been writing them down, so we don’t know what all of them were.”
Yeah, me too.
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