By Bill Rusteberg
Years ago when I was a sales representative for a health insurance company a disgruntled plan member cornered me, screaming her claim was denied. “Our insurance sucks! I pay a lot of premium and I don’t get anything in return!” she screamed for all to hear.
Just so you know, I was having a bad day as she was not the first to scream at me during the benefits meeting. I was just about ready to say adios to the insurance business and seek some other means to support my every want and need when brilliance struck.
“Ma’am, may I see your I.D. card? I asked. She searched her purse, found her health insurance card and handed it to me.
“Hmmm, Oh I see now…….Ma’am see that code on the lower left hand side, that indicates you are on a premium paying policy!” I noted.
“What’s a premium paying policy!” shouted the member in frustration.
“Ma’am, we have two policies here. One is a premium paying policy and the other is a claim paying policy. You choose the cheaper plan option, the premium paying option. That’s why your claim was denied. You should have taken the claim paying policy option!” I said.
Now utterly deflated, she asked sheepishly “I want a claim paying policy! How do I enroll on one of those?”
“Ma’am, look………..let me take your EOB with me. I will try to convert your premium paying policy into a claim paying policy, but I can’t guarantee I’ll be successful. I have a few favors owed by Home Office and I’ll try to pull some strings for you!” I assured her
“Thank you soooooo much. Thank you soooooooooo very very much!” replied the now formerly pissed off, now hopeful, plan member………………..
Oklahoma Bill Would Fine Health Insurance Companies That Do Not Pay Claims
“House Bill 2322, named the Health Care Freedom of Choice Act, would authorize the Oklahoma Insurance Department to hold hearings and levy fines on insurance companies that refuse to pay claims from ‘practitioners, hospitals, home care agencies, or ambulatory surgical centers despite them meeting requirements for compensation as laid out in the measure,’ according to the bill summary.” MORE >>
kpvi.com
