What about these #%&!$%$* insurance companies?


JLM
#1
Just heard on C.B.C. radio news, woman bought medical insurance and heads for Arizona. She ends up in hospital after suddenly getting sick. The Yanks submitted a hefty bill (somewhere in the range of 6 figures I believe)for numerous tests. Insurance a$$holes wouldn't accept it, said she lied when she filled out the form. She was asked how many prescriptions she'd had in the past while and she answered what she honestly thought was truthfully. Well the insurance a$$holes started digging and found one more prescription than what she stated. Well it turns out it was a prescription she never had filled. I've had several prescriptions I never got filled simple because the doctor gave the prescription but advised if I was better by such and such a day to just tear it up which invariably I did.
 
mentalfloss
#2
Insurance companies are usually pretty good at weeding out fraudsters so this is not surprising.

We should get some more info. on exactly what coverage she was entitled to and what was needed to support her claim.
 
petros
#3
Fraud is quite common. A lot of people think they'll get a second opinion or cured the US.
 
JLM
#4
Quote: Originally Posted by mentalflossView Post

Insurance companies are usually pretty good at weeding out fraudsters so this is not surprising.

We should get some more info. on exactly what coverage she was entitled to and what was needed to support her claim.

On the numerous times I've gone to the U.S. and bought insurance, they've always gave me a list of what's not covered and it's long including all criminal activity, acts of war, revolution etc. but otherwise I believed I was covered for whatever evolved. Otherwise why would a guy buy insurance?
 
petros
#5
Quote: Originally Posted by JLMView Post

On the numerous times I've gone to the U.S. and bought insurance, they've always gave me a list of what's not covered and it's long including all criminal activity, acts of war, revolution etc. but otherwise I believed I was covered for whatever evolved. Otherwise why would a guy buy insurance?

Travel insurance?
 
mentalfloss
#6
Quote: Originally Posted by JLMView Post

On the numerous times I've gone to the U.S. and bought insurance, they've always gave me a list of what's not covered and it's long including all criminal activity, acts of war, revolution etc. but otherwise I believed I was covered for whatever evolved. Otherwise why would a guy buy insurance?

An insurance policy is like an employment contract so you need to make sure you read through the entire thing and understand the fine print or you will get burned.
 
JLM
#7
Quote: Originally Posted by petrosView Post

Travel insurance?

Absolutely!
 
BornRuff
#8
Quote: Originally Posted by mentalflossView Post

An insurance policy is like an employment contract so you need to make sure you read through the entire thing and understand the fine print or you will get burned.

This kind of thing is pretty slimy on the part of the insurance companies.

They will happily accept your payments while you are healthy, but they have entire departments dedicated to trying to find mistakes in your application after you have made a big claim so that they can avoid paying.

No average person can fully understand the terms of these insurance contracts. The rules need to be set up so that they only target people who are actually trying to scam the insurance companies and omissions that have a significant impact on underwriting. Allowing them to weasel out of paying on a technicality like this is wrong.
 
JLM
+1
#9
Quote: Originally Posted by mentalflossView Post

An insurance policy is like an employment contract so you need to make sure you read through the entire thing and understand the fine print or you will get burned.

One word of advice- If you are going to travel a lot get a BCAA/CAA membership and buy the insurance through them. I think there is a higher degree of loyalty toward members than you would get from Joe Blow insurance you happen to spot on the street corner.
 
mentalfloss
#10
Quote: Originally Posted by BornRuffView Post

This kind of thing is pretty slimy on the part of the insurance companies.

They will happily accept your payments while you are healthy, but they have entire departments dedicated to trying to find mistakes in your application after you have made a big claim so that they can avoid paying.

No average person can fully understand the terms of these insurance contracts. The rules need to be set up so that they only target people who are actually trying to scam the insurance companies and omissions that have a significant impact on underwriting. Allowing them to weasel out of paying on a technicality like this is wrong.

People regularly go to court over ambiguity in policy wordings.

If there is a problem with the way it is written that is a perfectly reasonable legal defense.

Alternatively, if the policy has been properly communicated to them, then the insurance company has every right to deny a claim or ask for a revised application so they can ensure there is no possibility of misrepresentation.
 
petros
#11
Quote: Originally Posted by JLMView Post

Absolutely!

It's limited and probably won't cover preexisting issues as this woman found out the hard way.
 
IdRatherBeSkiing
+2
#12  Top Rated Post
Quote: Originally Posted by BornRuffView Post

This kind of thing is pretty slimy on the part of the insurance companies.

They will happily accept your payments while you are healthy, but they have entire departments dedicated to trying to find mistakes in your application after you have made a big claim so that they can avoid paying.

No average person can fully understand the terms of these insurance contracts. The rules need to be set up so that they only target people who are actually trying to scam the insurance companies and omissions that have a significant impact on underwriting. Allowing them to weasel out of paying on a technicality like this is wrong.

Insurance companies are legalized thieves and liars.
 
BornRuff
#13
Quote: Originally Posted by mentalflossView Post

People regularly go to court over ambiguity in policy wordings.

If there is a problem with the way it is written that is a perfectly reasonable legal defense.

Alternatively, if the policy has been properly communicated to them, then the insurance company has every right to deny a claim or ask for a revised application so they can ensure there is no possibility of misrepresentation.

This kind of litigious attitude drives up insurance costs dramatically. Not everything should have to go through the courts in order to be sorted out.
 
Locutus
#14
 
mentalfloss
#15
Quote: Originally Posted by BornRuffView Post

This kind of litigious attitude drives up insurance costs dramatically. Not everything should have to go through the courts in order to be sorted out.

There are many different factors which affect insurance costs and it's a bit disingenuous to just blame it on litigation. Also, in many cases these situations go to mediation and arbitration first in order to avoid unnecessary costs.

An insurance policy is a binding contract so it is subject to the same scrutiny as any other binding contract.

And insurance companies can't just give you money just because you claim ignorance. If they did that, you would also see an increase in premiums.
 
BornRuff
#16
Quote: Originally Posted by mentalflossView Post

There are many different factors which affect insurance costs and it's a bit disingenuous to just blame it on litigation. Also, in many cases these situations go to mediation and arbitration first in order to avoid unnecessary costs.

An insurance policy is a binding contract so it is subject to the same scrutiny as any other binding contract.

And insurance companies can't just give you money just because you claim ignorance. If they did that, you would also see an increase in premiums.

Who said it was "just" litigation?

Obviously there are lots of different costs, but litigation is a big one.

Rather than making sick people duke it out in the courts, the government can simply pass laws that limit the ability of the insurance company to do stuff like this, with enforcement mechanism other than simply going to court.

Otherwise these companies can just make their forms as complicated as possible to ensure almost everyone makes some sort of mistake that they can use to cancel their policy later.
 
Nuggler
+1
#17
Quote: Originally Posted by JLMView Post

One word of advice- If you are going to travel a lot get a BCAA/CAA membership and buy the insurance through them. I think there is a higher degree of loyalty toward members than you would get from Joe Blow insurance you happen to spot on the street corner.



Good one JLM. I usually get mine from the bank, but CAA has always responded positively to any claim I had. Moot point cause I`m not a traveller.
 
petros
#18
CAA's insurance is Blue Cross
 
mentalfloss
#19
Quote: Originally Posted by BornRuffView Post

Who said it was "just" litigation?

Obviously there are lots of different costs, but litigation is a big one.

Rather than making sick people duke it out in the courts, the government can simply pass laws that limit the ability of the insurance company to do stuff like this, with enforcement mechanism other than simply going to court.

Otherwise these companies can just make their forms as complicated as possible to ensure almost everyone makes some sort of mistake that they can use to cancel their policy later.

Like I said, this isn't as prevalent a problem as you make it out to be.

During the ice storm in Toronto there were many people who went to insurance companies to pay for their clean up and most were denied because their homeowners policy would only trigger a claim in the event that the tree actually fell on their house.

There was no legislative retribution like a class action because this was explicitly laid out in their policy in clear terms.

That is the biggest exposure you can find and any other serious disagreements are not going to break the bank unless there is a legislative dispute involving someone completely mangled in a car accident or slip and fall.
 
BornRuff
#20
Quote: Originally Posted by mentalflossView Post

Like I said, this isn't as prevalent a problem as you make it out to be.

During the ice storm in Toronto there were many people who went to insurance companies to pay for their clean up and most were denied because their homeowners policy would only trigger a claim in the event that the tree actually fell on their house.

There was no legislative retribution like a class action because this was explicitly laid out in their policy in clear terms.

That is the biggest exposure you can find and any other serious disagreements are not going to break the bank unless there is a legislative dispute involving someone completely mangled in a car accident or slip and fall.

We are not talking about simply not buying insurance that covers the claim. We are talking about having insurance to covers exactly what you are trying to claim, but having that coverage revoked after the fact because of a minor error on the application form.

We know that there is a huge information asymmetry between consumers and the lawyers who put these forms together, so there really needs to be laws on exactly what sort of errors and omissions can be used to cancel someone's coverage. Otherwise insurance companies will be able to craft agreements that let them pretty much deny anyone, and people seeking insurance would need to hire their own lawyer and doctor just to make sure they actually have coverage
 
JLM
#21
Quote: Originally Posted by petrosView Post

It's limited and probably won't cover preexisting issues as this woman found out the hard way.

Every condition is "preexisting" unless obtained by sudden accident.
 
SLM
#22
Quote: Originally Posted by JLMView Post

Just heard on C.B.C. radio news, woman bought medical insurance and heads for Arizona. She ends up in hospital after suddenly getting sick. The Yanks submitted a hefty bill (somewhere in the range of 6 figures I believe)for numerous tests. Insurance a$$holes wouldn't accept it, said she lied when she filled out the form. She was asked how many prescriptions she'd had in the past while and she answered what she honestly thought was truthfully. Well the insurance a$$holes started digging and found one more prescription than what she stated. Well it turns out it was a prescription she never had filled. I've had several prescriptions I never got filled simple because the doctor gave the prescription but advised if I was better by such and such a day to just tear it up which invariably I did.

Here's a more detailed article.

http://ca.news.yahoo.com/huge-medica...120000753.html

Quote:

In January 2014, AMA told McShane her claim was rejected because she had answered “no” when asked if she had “taken and/or been prescribed six or more prescription medications” in the last four months.
AMA said her medical records showed nine prescriptions.

McShane, who was a nurse before she retired, says she believes she had answered truthfully, because some of the prescriptions had been written but never filled, two were for drugs she hadn’t taken in months, and another was for an antibiotic prescribed by her Canadian doctor in case she contracted an infection while travelling, and which she never took.

I don't think there's much debate at all. They did not fill in the application correctly. Most likely it was unintentional on their part but, if that is indeed the wording on the application, then it's pretty clear if she received perscriptions then she had "been prescribed" the medication.
 
JLM
#23
Quote: Originally Posted by SLMView Post

Here's a more detailed article.

http://ca.news.yahoo.com/huge-medica...120000753.html



I don't think there's much debate at all. They did not fill in the application correctly. Most likely it was unintentional on their part but, if that is indeed the wording on the application, then it's pretty clear if she received perscriptions then she had "been prescribed" the medication.

That account is much more detailed than I heard on the radio, but pretty sleazy treatment. Sometimes doctors only reason giving a prescription is save another visit to the doctor, hence saving money in the long run. On two or three occasions my doctor has said to me, "I'm pretty sure what you have is so and so and it should clear up in x days, if it doesn't get the prescription filled". This is particularly reprehensible as she was already cleared for treatment.
 
petros
#24
There isn't enough details to pass judgement.
 
SLM
#25
Quote: Originally Posted by petrosView Post

There isn't enough details to pass judgement.

Well there never is in a news article but since when has that ever stopped anyone here? Lol.

Gotta talk about something.
 
mentalfloss
#26
Quote: Originally Posted by BornRuffView Post

We are not talking about simply not buying insurance that covers the claim. We are talking about having insurance to covers exactly what you are trying to claim, but having that coverage revoked after the fact because of a minor error on the application form.

Then you are talking about something that isn't even prevalent.

An insurance cannot 'revoke' your coverage for a 'minor' error on your claims application. If they do, then they've made a mistake or you simply have to fix the error on your application.


Ah, just read the article (finally).

Yes this one will be a problem because of the exposure and whether or not it was misrepresentation on the policyholder's behalf. There should be a cap on medical costs regardless - I have a hard time believing anyone would be insured for over $100,000 in medical fees.
Last edited by mentalfloss; May 14th, 2014 at 01:12 PM..
 
BornRuff
#27
Quote: Originally Posted by mentalflossView Post

Then you are talking about something that isn't even prevalent.

An insurance cannot 'revoke' your coverage for a 'minor' error on your claims application. If they do, then they've made a mistake or you simply have to fix the error on your application.

This is exactly what this thread is about. Did you read the OP?
 
JLM
#28
Quote: Originally Posted by SLMView Post

Well there never is in a news article but since when has that ever stopped anyone here? Lol.

Gotta talk about something.

Which is good, when the bastards get too complacent, they tend to rip you off even more.
 
mentalfloss
#29
Quote: Originally Posted by BornRuffView Post

This is exactly what this thread is about. Did you read the OP?

I was talking about a claims application.

This is about a policy application.

Okay I checked out AMA's coverage.

The limit is $5 million, so I think the insurance company needs to prove intentional misrepresentation if they want to make a case.

https://www.orioninsurance.ca/AMA/Do...y-Document.pdf
 
PoliticalNick
#30
Quote: Originally Posted by mentalflossView Post

I was talking about a claims application.

This is about a policy application.

Okay I checked out AMA's coverage.

The limit is $5 million, so I think the insurance company needs to prove intentional misrepresentation if they want to make a case.

https://www.orioninsurance.ca/AMA/Do...y-Document.pdf

If it goes to court the Insurance company will have to prove intentional misrepresentation of a nature that would have an effect for what she is claiming. If she is claiming she got cancer but has a prescription for cancer drugs then she will be denied. If she got cancer and all her medications are for migraines and heartburn she will most likely win.

This is a simple case of 'deny, deny, deny' which is a game the insurance industry likes to play where they deny almost all claims at first and then keep denying them hoping the client will get frustrated and give up rather than spend big bucks on a lawyer to fight for a few hundred or couple of thousand bucks. Most of the time their game works, occasionally they have to give a settlement.
 

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