Anybody see the report on CBS news tonight about Assurant and claims? It wasn't too pretty. I caught just part of it, but it has something to do with Assurant going back after policies are in force a number of years and denying big claims if anything comes up as a preexisting condition.
I know all carriers can do this, but it gave the impression they were really trying to get out of some big claims. Accusations of papers being shredded, claims personal being coerced, etc.
Again..i'm just the messenger. I write for these guys. And we all know how biased the media is.
Anybody see the report on CBS news tonight about Assurant and claims? It wasn't too pretty. I caught just part of it, but it has something to do with Assurant going back after policies are in force a number of years and denying big claims if anything comes up as a preexisting condition.
I know all carriers can do this, but it gave the impression they were really trying to get out of some big claims. Accusations of papers being shredded, claims personal being coerced, etc.
Again..i'm just the messenger. I write for these guys. And we all know how biased the media is.
Anyone see it?
When Rush Limbaugh says something about it my ears will perk up. If this was seen through the traditional channels, I find it lacking and flacid.
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[COLOR=#000066]"Tell me and I will forget. Show me and I will remember. Involve me and I will understand." Confucius
Rush or CBS who had a bigger population base and who do the majority of clients or the decision makers follow. CBS is just trying to scare people. Now if Al gore got behind Assurant and said that their denying claims was caused by global warming then I might get worried. But I think that is a stretch even for the biggest of the koolaid drinker. No offense Sti.
(CBS) As more Americans are unable to get health insurance through their work, they often turn to the individual insurance market. Last night we told you how difficult it can be to get individual insurance, with companies turning down people with the most minor of medical problems. CBS News chief investigative correspondent Armen Keteyian takes a closer look at what happens when some people who actually have individual insurance try to collect on an expensive claim.
Tod Smith, 54, was paying for an individual health insurance plan when he had a heart attack. It was only after he tried to collect on his claim that he learned how uncovered he was. (CBS)
Quote "I certainly figured that a heart attack was a catastrophic event. So I figured I was covered."
Walking along a stretch of road last summer, 54-year-old Tod Smith felt an intense burning in his chest and tightness in his arm — signs of a heart attack he never saw coming.
"I was in good health," Smith said. "No major health problems or conditions."
For Smith, an illustrator of children's books, his heart attack was the first shock. The second: more than $40,000 in medical bills his insurance company refused to cover — after he figured the company, Assurant, would pay.
"I certainly figured that a heart attack was a catastrophic event. So I figured I was covered," Smith said.
A two-month CBS News investigation of the individual insurance market found that Smith's experience was far from unique. Because it was expensive, his claim was investigated for fraud by Assurant Health, his insurance company.
After examining his medical records, the company refused to pay based on a 3-year old-reference to an "angina episode." Assurant said those words proved his condition was pre-existing, despite the fact that follow-up tests in the same file diagnose his "episode" as a case of acid reflux and ruled out a heart condition.
"The claim about these pre-existing conditions was absolutely preposterous," Connecticut Attorney General Richard Blumenthal said.
Blumenthal's office has investigated dozens of the more than 500 complaints nationwide against Assurant, a Milwaukee-based company that specializes in individual policies. Blumenthal charges Assurant has a pattern of "bad faith" when it comes to its customers.
"What this company did was create the illusion of coverage, when in reality, it would challenge almost any expensive procedure as a pre-existing condition," he said.
CBS' investigation of Assurant found a pattern of questionably denied claims and cancelled policies — and what a South Carolina judge called a culture of "secrecy, concealment … and shredded documents."
A video deposition from another court case describes what may have been cash incentives to the company’s medical director to deny claims after the fact.
Diane Winkowski, a former unit supervisor of Assurant, said she was part of a unit at Assurant that searched for reasons not to pay claims. She told us she quit because, she believed, many of the investigations were unfounded — and unjust.
"A lot of time we felt that we had it all, and to try and keep looking was frustrating," she said.
Assurant refused to discuss its denials of claims on camera, but it issued a statement saying it continually evaluates its claims process "to ensure it is fair, equitable and consistent with state laws and industry standards."
However, at least 15 states have investigated Assurant's practices, forcing the company to pay millions of dollars in fines. The company now faces dozens of customer lawsuits, with another on the way — from Tod Smith.
"It's about money," Smith said. "That's the bottom line."
Smith hopes his legal action will cover that $40,000 bill he felt assured his insurance company would pay.
Being new in the business, articles/news stories like this are always an interesting read. In Michigan, BCBS has to issue a policy to an individual, regardless of pre-existing conditions. Obviously, they are subject to a 6 month waiting period before they can receive treatment for any pre-existing, but still.. .they CAN get coverage. Yes, it's expensive... but available. I guess my question is... is this not the case in all states? I read some of the articles about people not being able to find any company to insure them. How do other states work? Is there not a company who has to guarantee coverage? Like I said... I'm new, and learning more and more each day. Figured this is always the best place to ask questions!
Disneyland.....hahahahahaha....I can see the comment section hammering the individual market.....
'm single mother with degenerative disc disease. I can only work 30 hours a week and cannot afford the insurance available through my job. After years of paying medical bills out of pocket, I HAD to relenquish my pride and put my daughter and myself on state-sponsered insurance. I have a good primary care doctor, but can't get any kind of specialist - they just won't take my insurance. All my doctor can do at this point is try to get me medications so that I can function, but to no avail - they aren't covered. I have spent countless hours on the phone and driving from my doctors to the pharmacy and back again. Health Net continues to use every stall tactic in the book - taking well over a month while I scramble for "pre-authorization" and "medical necessity forms", even outright lying to me and offering me over the counter alternatives only to finally deny them. Of course, they give themselves another two weeks to "review" my appeal...while I wait in agonizing pain. How is this right? Posted by JTRUE67 at 09:02 PM : May 24, 2007 + report abuseSee, this doesn't happen in other Western Nations because they have universal health coverage. Goodness, put these vicious sharks (health insurance companies) out of business!! They shouldn't be alowed to pray upon our weaknesses. Posted by rudy654 at 08:00 PM : May 24, 2007 + report abuseI can't believe someone finally lifted the rock to reveal the heartless, conscienceless moneygrubbing evil that is Fortis/Assurant. Four years ago I was struck by a mystery illness that left me with crushing exhaustion, confusion, joint pain and heart symptoms. Unfortunately, my disability was through Fortis. When I told them I was so sick I was barely able to rise and shower let alone drive, they told me to take a bus to work. I spent two years, sick as a dog, with morphing symptoms, fighting for disability. I finally received my diagnoses just as they were to give the final determination - Lyme Disease. Fortis laughed. DENIED. It took another two years after IV treatment, careful attention to my health and a move to a warmer, less polluted environment to get my strength back. Meanwhile I have lost everything I worked a lifetime to earn - including my home. Alone, struggling, 56 yrs old, uninsured and probably uninsurable, my biggest fear is that my health will fail again and my family will go down in flames financially trying to save me. I would, quite honestly, rather die. Posted by mickisuzanne at 07:27 PM : May 24, 2007 + report abuseI would like to know how these insurance companies are getting away with this. I was hurt in work. I had given my employer a doctors note not to put me on a certain machine. The employer put me on it anyway. My back blew out. Now I have been fired from my job. Lost my health insurance, and am being told it will cost me thousands of dollare to be insured because I have a pre-existing back and heart problem. Pre- existing. It wasn't pre-existing when I worked. Now it is pre-existing. I had insurance when it all happened. I was fired from my job and my insurance was taken away. How can this happen to an American who has worked and payed insurance for over 35 years? The insurance company for workers compinsation dosn't want to pay either. So now I may loose my house I'v been in for over 18 years. I have writen to the govener and the local news stations and they all say it isn't anything they can work on. Why is that? Someone is having a problem loosing $40,000. I am going to loose over a million due to my employers neglect and there isn't anything I can do? What a wonderful world. Posted by nepats1234 at 07:21 PM : May 24, 2007 + report abuse
Being new in the business, articles/news stories like this are always an interesting read. In Michigan, BCBS has to issue a policy to an individual, regardless of pre-existing conditions. Obviously, they are subject to a 6 month waiting period before they can receive treatment for any pre-existing, but still.. .they CAN get coverage. Yes, it's expensive... but available. I guess my question is... is this not the case in all states? I read some of the articles about people not being able to find any company to insure them. How do other states work? Is there not a company who has to guarantee coverage? Like I said... I'm new, and learning more and more each day. Figured this is always the best place to ask questions!
Definitely not here in California. All individual coverage is underwritten and applicants can be denied coverage based on health history. The only option in that case is major risk pool or group if a job comes along.
Time writes more STM than almost anyone. The liberal underwriting & 5 yr lookback make it easy for them to be a target for this kind of journalism.
I am not a fan of Time, but this looks like a setup.
I think you are right. Most individual and family I see (not STM) have a 2 year contestability period. I have not looked closely at the STM products since I really don't sell them. STM to me is an instant setup for failure. A few simple questions and you are enrolled. Post claims underwriting seems dangerous to me, and I think this story points out just how dangerous it can be to the subscriber.
You're thinking like an insurance agent Salpro...no offense..but it really doesn't matter how you feel about it. How will the public perceive it?
Funny thing, I thought I was an insurance agent
No offense taken! Take into consideration that we are both right. It does matter how I feel about it because I am honest with my clients and they believe what I say because I convey that I am trustworthy. In fact, if we ever do get a national health system, I will gladly change roles from a commission only position to charging clients hourly fees for my time to help them navigate the "system." Consumers Reports is what I run into a lot and I have a lot of respect for that publication.
The majority of the public is liberal. The majority of my clients are not. I had a wonderful conversation with a nice lady who wanted to hear my thoughts on Hilary Care yesterday. Makes me want to move to Virginia.
I think you are right. Most individual and family I see (not STM) have a 2 year contestability period. I have not looked closely at the STM products since I really don't sell them. STM to me is an instant setup for failure. A few simple questions and you are enrolled. Post claims underwriting seems dangerous to me, and I think this story points out just how dangerous it can be to the subscriber.
I am under the impression that the 2 year period is standard for all life/health products. Correct me if im wrong.
Isn't the 2 year look back for life insurance only?? I heard somewhere that health insurance companies can look back as far as they want for a major illness. And as we see here they can!!
I just had one of my clients diagnosed with stage 4 cancer not too long ago. She's only been on the plan for 3 months before it was diagnosed. Funny thing is I took her off an Assurant plan with a 2k per year Rx drug cap. Who know what would have happened otherwise. I put her with World and after verifying she had prior credible coverage and no prior history of cancer it is being paid. I just saw the first EOB, everything is being covered 100% minus her deductible.
I guess some companies have very strict rules and guidelines when a major claim comes in, trying to find a reason to deny the claim is messed up though.
I'm also a big fan of the telephone interview that some companies do. If the client leaves something off the application on purpose, and also fails to disclose it on the telephone interview it's on the client, not the agent!!
Yet another reason I require the client fill out the application as opposed to me. You really can't trust some people out there in this sue happy world!
I'm also a big fan of the telephone interview that some companies do. If the client leaves something off the application on purpose, and also fails to disclose it on the telephone interview it's on the client, not the agent!!
Yet another reason I require the client fill out the application as opposed to me. You really can't trust some people out there in this sue happy world!
I'm starting to think that in this day in age it doesn't really matter who fills out the application because a lawyer will find a way to win. I feel comfort in keeping meticulous notes on all applicants and storing them in a safe place.
"Ok, Mr. Agent, you did not fill out the application, but she said you told her to put this down and leave this out. "Oh yeah, prove it!"
"Ok, Mr. Agent, we know you filled out the application for my client and even though she submitted a verification link (assurant), got a phone interview from the insurance company (World, Assurant, GR, etc.) and submitted the acceptance letter (Assurant), and went past the 10 day free look period (all companies)....You are at fault! "Hmmm, there once was a man from Nantucket who told a lawyer to #$#$ IT!
I might get flack from this but in Ohio (see attached)..a few years ago Assurant had THE HIGHEST complaint ratio. In 2005, they were also VERY high. 2006 figures for Ohio are not out yet.
Click on the link or a United American Agent will move into your basement.
Assurant on CBS news tonight
Check out our individual insurance resource page
Watch Keteyian’s interview with Maria Locker, who was given the health-care run-around when diagnosed with lymphoma
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