|Sigforum K9 handler|
But, in health care, that's a preexisting condition.
"Make it a shooting, and not a gunfight" LSP552 02/19/2011
Thats typical but one of the most asinine things I've heard! I got a similar reply once when I called and asked about a large increase on my auto, and the insurers (Allstate)reply was it's because I live in Florida???
Regards, Will G.
Bought a new to me truck on December 10th. Just give me the Same insurance company. Just give me the same coverage as the other car. I get my information in the mail and I have zero collision coverage for about 500 miles of use . When I called, she says I was lucky not to have had a accident in that time. Really? Was I the lucky one? Why did you take the lien holder info so carefully it you weren’t going to protect them?
Does anyone simply do their job with competence any?
"The days are stacked against what we think we are." Jim Harrison
Son had a visit to urgent care. Got labs, I got a bill for that which was understandable, they covered this much you owe this much. Lab bill paid immediately.
Primary insurance sends me things that look like bills but say "this is not a bill" and have some stupid language about we are negotiating with your providers. Um, call me stupid, but the insurance is run by the same people that run the urgent care (where my son went), CT and the hospital for that matter. How in the hell do they negotiate with themselves? They should know the costs, period. Anyway, I called on the "this is not a bill" so I could get the final amount. Their billing couldn't tell me, their excuse was "we are still negotiating with the providers. Oh, you mean you own company?
Fast forward to yesterday and I get a bill from the insurance company, the amounts are exactly the same as the amounts on the "this is not a bill." I take it the negotiations didn't go well? The amounts are several hundred dollars and I still can't tell what we are being charged for. I have to call on Monday.
I would give my left arm to call a drone strike in on them.
What really pisses me off is that I have a graduate degree and I can't make heads or tails of the bills. I imagine that older people have the same problem and I bet they get screwed over with them.
|Gone but Together Again.|
Dad & Uncle
Here is how it should work...
You incur a claim. If you went to an in-network provider under your health plan then that provider is under a contractual obligation to:
1) bill your insurance,
2) not bill you until your carrier adjudicates the claim,
3) if their original bill to the carrier exceeds the pre-determined contractual amount, then the provider has to write off the excess.
Next is the carrier sends out an EOB (Explanation of Benefits) to both you and the provider. Lastly the provider sends a bill if there is any balance due.
If you go to an out-of-network (OON) provider, then items 1, 2, & 3 are thrown out the window and you will owe whatever the provider wants to charge and the provider is not under any obligation to bill your carrier.
The thing that stinks is you can go to an in-network hospital, use an in-network ER doc, but, let's say the radiologist who reads the xray is OON. Then your obligation is split like in the example above. This situation is what the media calls "surprise billing" and is getting national attention because insureds are trying to remain in-network but have zero control over any OON "ancillary" providers.
I hope this helps as when I read your post I was confused.
And that makes perfect sense, but my insurance company doesn't seem to do it that way.
Guess I'm gonna be the wet blanket in this hating on the insurance companies party
If it's leaks due to other than a catastrophic or otherwise unforeseen event, e.g.: Due to age, then, yes: It would be maintenance. It's not a service contract, it's insurance.
You're going to hate this next part even more: If you suffer damage that would otherwise not have occurred as a result of failure to maintain you may find you're not covered, either.
Had this happen to a buddy. Got ice dams on the roof. Water backed up and leaked down the inside walls, destroying the paint and underlying plasterboard. He filed an insurance claim. They covered it. It happened again. They told him to go fish, because, after the first incident he had no excuse for not knowing better than to allow it to happen again.
And, if you liked all that, you'll like the following even more.
There is a thing called "code and ordinance" coverage. It's often optional. It works something like this: Say a tree falls on your home. The electrical service entry wasn't directly affected, but is close enough to be affected by the repairs. In the process of acquiring the permits to fix the insured bits the contractors discover your electrical service entry is no longer up to code and the permitting process demands that be addressed. Since that part of the repair didn't result from damage, but from a code or ordinance change: Might not be covered.
I discovered that one entirely by happenstance. Quickly contacted my agent and had the code and ordinance rider added to our policy.
"America is at that awkward stage. It's too late to work within the system,,,, but too early to shoot the bastards." -- Claire Wolfe
"If we let things terrify us, life will not be worth living." -- Seneca the Younger, Roman Stoic philosopher
"The dominant media is no more ``mainstream`` than leftists are liberals." -- me
I know its a funny Photo, but the office manager was pinned and killed under the car. I was there.
|Facts are stubborn things|
Insurance companies are in business to collect premiums not to pay claims...
Insurance is a contractual relationship where the one paying the premiums frequently is unfamiliar with what exactly they are paying for. This is really prevalent with employer provided health insurance.
Do, Or do not. There is no try.
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