Thursday, July 15, 2004

Episode 3 - Private Health Insurance...Disputing the Riders

After further discussion with my agent, he recommended I call underwriting (customer service) at Fortis to discuss the riders placed on my policy. The subsequent phone call lasted over an hour while I spoke with two different representatives. The first representative knew very little and in fact had no real information but spoke as if I knew nothing. It felt like a textbook case of being talked down to.

The second representative actually had the information used during underwriting. As it turns out, even though underwriting knew of the EMG and MRI, they based all of their decisions on the Doctor's notes from the appointment where he ordered the EMG and MRI. So, not only did they know about the tests because I told them, but the Doctor's records should have also shown the EMG and MRI being ordered.

So, the riders have been explained, but my experience with the customer service representatives has helped me decide not to accept the insurance. Here are a few statements the representatives made during the call:

  • In response to me asking about a higher premium to get surgery or even just complications of surgery for Otitis Media (ear infections) covered..."We're not going to solve all of the insurance industry problems right here on the phone today."

  • In response to me asking what information the first representative was looking at in telling me they didn't have records that underwriting had clearly told me they would order..."I know nothing." This isn't a joke...that's what she said. I then asked to speak to somebody that did know something, and she transferred me. I figured she'd hang up.

  • In response to me asking why I would trust their claims department given their attitude on the phone..."That's a decision you'll have to make."

  • In response to me asking if he thought there was a problem with their research based on not retrieving the EMG and MRI results that they knew about..."No."

Needless to say, I wasn't too impressed. Admittedly, I was combative on the phone, but I do that intentionally to see how they react. Dealing with ISPs, I've often found that if sales can't be polite, technical support will be a nightmare. I'm guessing that if customer service for health insurance is poor when you're trying to GIVE THEM MONEY, it could only be worse when you're trying to take money.

The next step is to look into Blue Cross Blue Shield. Unfortunately, they do not offer an HSA and as such, our medical expenses would not be tax deductible. Don't believe the crackpot accountants they have on TV shows that tell you all of your health care costs are deductible. In truth, only the amount of expenses that exceed 7.5% of your adjusted gross income are deductible.

It's interesting to note that Miscellaneous itemized deductions have a floor of 2%. Given that a lot of Miscellaneous deductions are fraudulent, it really makes you wonder about the logic of our elected representatives. Removing all taxes from the healthcare system would go a long way toward reducing the burden on all Americans.

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