"OK, we will send you a check, but we don't want to know where you spend it."
I have collected many strange quotes from my insurance provider over the years. Once in a great while, it has given me insight into how they are constantly covering themselves from any liability or future costs based on any action taken. Many of the problems I have had have to do with my private, or individual policy and would have been handled far differently had I been covered by a Group policy.
My wife had very severe ligament problems and this happened during a 6-7 year saga to find a way for her to return to a normal life. We had called for Pre-Certification on multiple procedures for months assuming and was told that the Pre-Certification was complete.
Over $30,000.00 of expenses had not been paid (except by my faithful credit cards) and I had been writing and calling the insurance company for months with no real decision on the bills that had been "pre-certified". After at least 6 months of contact, I was told that the treatment was not "medically approved" for her condition and they would not pay. After many more calls, I was passed along to one of the higher-ups at the company and was told that, "We will send you a few thousand dollars, but do not want to know where you spend it."
I learned 2 things from this ordeal:
1. This is as close to an apology as you will ever get from your insurance company. They had not responded as to acceptance or denial for many months while we were building up costs and knew that there was a possibility of losing on appeal.
2. There was a very good reason for not wanting to know how the money was spent. If they would have applied the payment to a small part of any of the bills, it could have created a precedent for covering that procedure in the future.
To make someone feel like they are doing you a favor when they actually have been wrong (or even negligent) in their inaction has to take years of training.
I am a firm believer in the Private Sector being the catalyst for most of the transactions in the country. But, it only works if there is truly competition as in Group Policies and not if you are refused coverage for "pre-existing" conditions if you lose or change jobs.
TVP
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My wife had very severe ligament problems and this happened during a 6-7 year saga to find a way for her to return to a normal life. We had called for Pre-Certification on multiple procedures for months assuming and was told that the Pre-Certification was complete.
Over $30,000.00 of expenses had not been paid (except by my faithful credit cards) and I had been writing and calling the insurance company for months with no real decision on the bills that had been "pre-certified". After at least 6 months of contact, I was told that the treatment was not "medically approved" for her condition and they would not pay. After many more calls, I was passed along to one of the higher-ups at the company and was told that, "We will send you a few thousand dollars, but do not want to know where you spend it."
I learned 2 things from this ordeal:
1. This is as close to an apology as you will ever get from your insurance company. They had not responded as to acceptance or denial for many months while we were building up costs and knew that there was a possibility of losing on appeal.
2. There was a very good reason for not wanting to know how the money was spent. If they would have applied the payment to a small part of any of the bills, it could have created a precedent for covering that procedure in the future.
To make someone feel like they are doing you a favor when they actually have been wrong (or even negligent) in their inaction has to take years of training.
I am a firm believer in the Private Sector being the catalyst for most of the transactions in the country. But, it only works if there is truly competition as in Group Policies and not if you are refused coverage for "pre-existing" conditions if you lose or change jobs.
TVP
Posted by The Virtual Patient at 2/25/2009 5:44 PM 
Categories: Costs, Pre-certification, Private Policies, Appeal denial, Pre-approval
Tags: precertification Private Policies coverage cost preapproval reasonable and customary
Categories: Costs, Pre-certification, Private Policies, Appeal denial, Pre-approval
Tags: precertification Private Policies coverage cost preapproval reasonable and customary
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