Mnemosyne has been on fire in comments regarding what to do when you think an insurance company is screwing you over:
Assuming he hasn’t been able to appeal successfully to his insurance company, I’ve been strongly encouraging people to file complaints with their local insurance regulators and with HHS. …It’s really, really important to let the state and federal regulators know whenever an insurance company does something hinky, because if consumers don’t report it, they won’t know….
I say, complain anyway. Make them explain to the state and to the federal government that it was someone else’s fault while providing boatloads of documentation. My husband works in healthcare and whenever a state regulator shows up, it’s a really big deal.
Am I advocating that you be a nuisance and make the state investigate things that are probably legal on paper just to annoy the insurance company? Yep!
She is exactly right. If you are unhappy with your insurance company complain. If the front line staff can’t satisfy you, complain some more. If the management staff can’t satisfy you, complain to the c-level while CC’ing your complaint to the state regulator, the local newspaper, local competitors and the effectively annoying investigative reporter. Even if what the insurance company is doing is legal, at that point, the Andy Rooney rule comes into play — C level execs don’t want to be chased down the hallway by Andy Rooney and the 60 Minutes camera crew, so a solution will often be found.
A short story here — as part of the Mayhew Insurance Exchange offerings, we offer a very narrow network product. It is fundamentally designed to keep people away from an expensive chain of hospitals. All of the marketing material has 72 point warnings saying that we won’t cover non-emergency services at That National Hospital Chain. Someone bought that product and then three weeks later had an elective surgery at That National Hosptial Chain. The individual in question had received a denial of authorization and a follow-up phone call to say that the surgery would be authorized at the other three hospitals the surgeon had privileges at, but not at Hospital X. The bill was denied as out of network, and the person started to complain that we engaged in unfair and deceptive advertising.
The complaint escalated to the C-level and local reporters within a week, and there was a massive meeting to determine if we unfairly screwed the person over. Legal was of the opinion that we were in the clear, and marketing/PR ran the calculation that is was cheaper for us to pay the claim then to take the hit from several thousand pissed off words in the local paper. We paid the claim as if the member was in network.