For many years, I have been covered under my wife's medical plan. In addition to Med, Den, Vis, we have always opted for additional plans, in the event we need it.

We are paying for Optional Hospitalization Indemnity plan (which is supposed to reimburse us for hospitalization). We also enrolled for Critical Care plan, (which is supposed to pay for critical health conditions such as Cancer).

With my recent health condition, we filed claims for both Optional Employee Benefits that we have been paying for so many years. We paid for the premium hoping that we will NEVER have to use it. But in the event it does (which it did), we are hoping those will help us pay for deductibles, etc.

Nope. Or at least, not yet. We have been going back and forth, sending papers after papers and spent hours with our doctor's office record staff, following-up and requesting them to send medical records. I signed all consents.

MetLife is the one processing the claims. Talking to their Reps is like talking to a 2nd grader. One call, they said they are waiting for some papers from Dr. A. I asked what number they faxed the request to and when. They can’t give me information. I called Dr. A office and asked if they received any request from MetLife. Nope.

Called Metlife again few days later. Now they are saying they need some more information from Dr. B and C. And it just keeps going.

Just frustrating. Makes you feel that they just want you to throw your hands down and just STOP filing claims.

Nevada Dept of Ins online consumer complaint link

Dept of Ins loves to contact carriers on these things, generally it costs the carrier for every complaint they have to follow up, and if problems are found, penalties.

http://doi.nv.gov/Consumers/File-A-Complaint/

quote:

Makes you feel that they just want you to throw your hands down and just STOP filing claims.

They do. Exactly. Their entire business model is to take in way more than they pay out, and any way they can do that is a good thing from their perspective.

Same thing with me and the birth of my 3rd child. We used a midwife and paid out of pocket. I have been fighting for reimbursement for 8 months now. Still no reimbursement. Seems like every time they are “missing” paperwork.

And that is what gets you frustrated. I am very good at keeping copies of ALL documents, test and lab results, receipts I paid for, etc. I offer to send them copies, and have them verify. Nope. They want to get whatever they need to process the claim themselves. That is fine. But they need to get to the right people at the hospital and doctor’s offices. Otherwise, their request will just sit on someone else’s desk (if they really even sent a request).

quote:

Originally posted by ffemt44: Seems like every time they are “missing” paperwork.

Reminds me of my last employer's disability insurance coverage.

Due to a pre-existing Cardiac condition I was told that they would not cover anything related to that for three years after treatment. Well now comes the problem.

Even though my bypass was in early 1998, fast forward to 2008 when I changed employment. The way it was explained to me by HR and the company's insurance broker if I was treated for anything related to the bypass there was a three year period that they would not pay disability for. But the good part was that they considered each and every checkup and or routine yearly stress test as a restart of the three year exclusion period. So If I quit seeing my Cardiologist and never refilled a prescription after three years they would cover me if I had a Cardiac related incident.

Made perfect sense to me......NOT!

(Obviously I never signed up for their disability insurance)

Call your state office that regulates insurance.

Those optional insurance scams/programs must be owned by the same group that owns all the home warranty/auto warranty scams/programs.

A bunch of "expletive deleted" fill-in-the-blank _____________.

Wife called MetLife yesterday. She was told it takes 19 days to review the claim. Hopefully they have eveything they need to “fully review” the claim. After that 19 days, I will be filing complaint with Nevada Dept. Of Insurance as suggested.

To this date, I have paid my Medical Health Insurance deductible of $4,500. Still have to pay 20% of any remaining bills from my surgery. Any reimbursement from those Optional Plans we paid for will help us with the remaining bills. I am thinking of dropping those optional coverages this ooen enrollment.

quote:

Originally posted by shovelhead:
Reminds me of my last employer's disability insurance coverage.
Due to a pre-existing Cardiac condition I was told that they would not cover anything related to that for three years after treatment. Well now comes the problem.

Even though my bypass was in early 1998, fast forward to 2008 when I changed employment. The way it was explained to me by HR and the company's insurance broker if I was treated for anything related to the bypass there was a three year period that they would not pay disability for. But the good part was that they considered each and every checkup and or routine yearly stress test as a restart of the three year exclusion period. So If I quit seeing my Cardiologist and never refilled a prescription after three years they would cover me if I had a Cardiac related incident.
Made perfect sense to me......NOT!
(Obviously I never signed up for their disability insurance)

WTF? You would think that checkups or stress test would be WANTED by the insurance company to tell them that you are a lower risk and they can keep their (your) money!
Reason #2037 I HATE INSURANCE COMPANIES!!

KMitch200, their reasoning left me scratching my head too.

quote:

Originally posted by ador:
Wife called MetLife yesterday. She was told it takes 19 days to review the claim. Hopefully they have eveything they need to “fully review” the claim. After that 19 days, I will be filing complaint with Nevada Dept. Of Insurance as suggested.

To this date, I have paid my Medical Health Insurance deductible of $4,500. Still have to pay 20% of any remaining bills from my surgery. Any reimbursement from those Optional Plans we paid for will help us with the remaining bills. I am thinking of dropping those optional coverages this ooen enrollment.

I don't know Nevada law, but often there are additional statutory penalties for bad faith claim denials. Just something to keep in mind if they keep dragging their feet.