medical insurance tid-bit

More detailed information about my policy findings will follow in a few days, but I just HAD to pass this one along.

I had a two hour face to face meeting this morning with a genuine, sitting at the planning tables and some board meetings level, muck-a-muck from "A Really Major National Health Care Carrier".

ONE of the things I found out was that ALL of the claim forms that go into their particular system go to Salt Lake City. At that point they are optically scanned and beamed to an office building in GHANA of all screaming places.

It is in Ghana where they are actually deciphered and processed, buy $2 to $3 an hour people who, as this person said, doesn't always know the English language. For instance, William is NOT the same to them as BILL or Wm. so the claim that mixes the script or doesn't match the computer records exactly is denied. Very minor breaks in nomenclature or punctuation form what they have been trained for will also cause the claim to be tanked.

Another, was that LARGE companies, such as Lowe's, Sears, Target, you name it, use the carriers only as administrators. They in essence are self insured and use the expertise of the carrier only to administer their stuff. This way they have only about a 2 percent cost to their policies. In order to make up the difference in what it really costs to provide and administer coverage for the rest of us, single user and small businesses, the margin is.... ready for this....NEVER less than FORTY PERCENT. My $900 a month premium represents a minimum $360 NET PROFIT ever month.

The killer was....and we have always known this....that the processing is deliberately structured in such a way to confound and irritate the living s*** out of a claimant with the often realized hope that said claimant will just throw his/her hands up and pay the thing without putting up more fight.

Nice, yes? LOL

Jack

When you consider that we are about to start to add on line systems with all of our medical as part of the stimulus plan it is a little scary. The reason for doing is somehow to save cost in the system. They will arbitrarialy require that the work be done in the US using US workers and maybe even Fedral civil service system workers. Now each of those will cost about $60 an hour compared to the $3 they are paying in Ghana. I am at a little loss as to where the savings will come from to pay that overhead.

I also heard today and read on a web site that they have removed the work requirment from the Welfare procedures going back to where we were prior to 1996.

Another change in the Senate was to remove the requiremnt for checking ID of all the contractors who are working for the contractors on the stimulus projects. It was in the House Bill and the Senage took it out to help the illegal immigrants.

Does anyone have a good source for the above issues.

Not to high-jack the insurance aspect of the thread but...

Let's see...

If the State regulates the insurance carriers, as they do in NC, to the effect that they CANNOT lose money or are allowed to just drop out of the state if they feel it necessary, then the carrier will hike the living s*** out of the premiums in order to maintain the present margins. If Federal employees are utilized I think that your $60 an hour estimate is going to be WAY too low and the sky will be the limit.

Welfare? Work? You must be kidding! The two are mutually exclusive and never the twain shall meet. The change is something to be expected.

Come on Richard!!! Who really gives a damn whether a worker putting together a bridge or a rocket knows what he is doing, or more importantly whether he just happens to not install a bolt correctly or even if he brings "his own bolts" to work with him?

All that matters is that the vote is cast in The Proper Manner. LOL

Jack

PS: Aw shucks, and here I am running off at the mouth after swearing that I had given up on the political discussions. Sorry! LOL

GHANNA!!!!!!!!!! I rest my case,this my friends is the reason we are failing.Keep outsourceing those jobs to places like this!!

It's not just insurance--you should try to get service for your Dell computer. They sent me the wrong OS CD's when I ordered them. Then wouldn't give me a return number. When I finally got them to realize that the CD's were wrong it was past the 21 day return limit. Round-and-round--I got to the point that I would request a manager who worked in the US (then I'd get another Indian or Pakastani and just say thanks, click). Finally, I just sent the CD's back to corporate in TX and told them to send me straight to collections because I was not going to pay for the wrong CD's. I also informed them that I would not purchase another Dell, period. Eventually, after ~9 months, I got a call saying, "Gee we made a mistake and will correct it." They were hoping that I'd just give up and pay the bill. Even at $1/hr, I sure they spent more try collect from me than the original bill was worth. GRRRRRRR

Steven,

It is all a choice. And it is one we all have to make. We can pay and extra $100 for the Dell computer and speak to someone in the US with a US accent and name. Or we can pay $100 less and buy something else and with that we accept a few complications.

I just bought a replacement for my HP computer and dealt with someone in, who knows where until I had to pay and then got transferred back to the US.

I also just finished a major remodel of my house and had 4 computers installed in various rooms. They were all built locally by US citizens and installed by US citizens. I never had one issue or problem that was not dealt with by the local English speaking US citizen. However I assure you it was significantly more expensive than if I had called up DELL or HP. I choose to buy American at every opportunity and have never owned a foreign car.

It is all choice.

Steve Y, has made his choice he wants protectionism and buy America. He has not dealt with the cost issue yet and does not seem to care that the price of his goods will go up by 30 or 40%. He doesn't care he wants everyone to have a living wage based on some chart or need. I made my choice for my particular situation.

I just worry about those who already struggling to make ends meet and then we force the companies to change to match what Steve wants and prices for commodities rises by a significant amount which is inflation and inflation that we caused which is over and above any natural cyclical inflation. What about the families that go to Wal Mart and Costco and all of a suddent prices are up $30%.

Maybe it made a difference whether you bought the computer from DELL. Maybe you would not have bought it if it was American made for an additional $200 or $300 dollars.

Karl, I don't count that, it is a hobby and I bought it from a poor unemployed guy in torn jeans. Does that help. If it was new I would not buy it. I would buy a Corvette even though the Corvette factory is where they send all the old UAW guys.

"The killer was....and we have always known this....that the processing is deliberately structured in such a way to confound and irritate the living s*** out of a claimant with the often realized hope that said claimant will just throw his/her hands up and pay the thing without putting up more fight"

I've payed premiums for Long Term Disability Insurance for years only to find out in September that I had to get a lawyer (blood sucker gets a third) to get the pricks to pay. Seems it's a well known scam that they deny everything as well, as no goverment agency regulates them.

6863m Wrote:

I called Intuit (QuickBooks) last week about some problems I was having with check-stock varying from 8-1/2" wide up to 8-3/4" wide and jamming my printer. I went through a progression of tech-types who could speak little English and I could speak no....what ever language they speak in Pakistan or Bangladesh. What a total waste of time...

By the way, Dell recently announced that for an extra fee, they would route their customer's tech calls to a US tech center.

A extra fee!! What nerve! Just so you can understand someone after buying there product.

Just to play the devil's advocate, I recently had a problem with my internet software and called customer service. Got a very polite, methodical, knowlegable, and patient person who was obviously Indian. This person walked me throught the procedure on my computer to repair the problem (it was a virus) and it worked perfectly afterwards.

Not saying I like seeing these jobs go overseas, and I would much rather they stayed here, but it hasn't been my experience that it's a nightmare to deal with folk in India.

Steve, my post was accurate and you know I don't drink or tell jokes. You have not thought through the issue from start to finish to determine who gets hurt. It is not complicated economics. It is all about the end price of the product. It is as I said a decision each of us make each day. I made mine and you made yours.

I just have thought through the whole process from start to finish. I have been consistent that I support fair trade and I am honest enough to know we are getting the short end of the stick. But it is one step at a time. I also believe there is a cycle of a Nation and if allowed to they will go from agrarian to industrialized because it improves the basic life of any human being. There are hundreds of examples of successful transitions like Japan China and Korea. We were saying the same thing about them in the early 50's.

Now we are beating up the Indians, Mexicans and others. They have to go through it. At some point I hope a true African Nation will start the process and India and Mexico can beat them up. We should support that process unfortunately the Leaders of these Nations will not because they can not control a public that can see freedom and a better life. It is just basic human evolution.

Richard i dont drink or tell jokes either,i guess we'd be no fun at the party

I tell jokes and drink.

Just wait until your insurance carrier requires you to travel to India or Pakistan to get an operation because it will be cheaper that having it in the US. You think I'm kidding, but IMHO, it's just a matter of time.

Not meant to be racist, but it fits this thread, and I thought it was funny.



The Red Dot

FINALLY, SOMEONE HAS CLEARED THIS UP.


For centuries, Hindu women have worn a red dot on their foreheads. Most of us have naively thought this was connected with tradition or religion, but the Indian Embassy in Washington, D.C. has recently revealed the true story. When a Hindu woman gets married, she brings a dowry into the union.

On her wedding night, the husband scratches off the red dot to see whether he has won a convenience store, a gas station, a donut shop or a motel in the United States. If nothing is there, he must take a job in India answering telephones giving us technical advice.

Now you know.

Jack, this is what Mary jane has done all her life, GET THE MONEY FROM INSURANCE COMPANIES, ok sorry for the yelling, but trying to make a point. MJ now works for what I like to call a mega-dentist practice, two going on three locations, abut 75 employees, and 150+ patients a day. Long before they got this big she discovered about $750K in abandon claims for the very reason you just mentioned, this is so common among doctors, they lose a buttload each year, because they don't have insurance specialist, and doctors ain't the best businessmen. MJ more or less created herepostion in this company and now has a staff of three folks working under here, they are more tripling thier salaries in wha would have been lost money. MJ is a freaking head hunter when it comes to getting insurance companies to pay off. Shae at one time decised to do this as independat companies for other doctors, but doctors are so lame business wise, they couldn't even see the need for it, needless to say the partners where she works now love here, hell she saves them enough money for each of them to buy a new Benz or Bimmer each year, everytime she gets pissed off they just give her a raise :)

TT Wrote:

twigworker Wrote:

Steve, I am not a big fan of oppressive Government regulation but I am pretty sure the Company he was referring to is highly regulated by the Government. All insurance companies are. I would not think a long term care company would be any different. Even though they are out on the fringe of the industry.

Something to be concerned with if they are not. The most important regulation they comply with is funding requirement ratios. And that would be very important to me.

The bastards.....



(I thought the Red Dot was funny). I might also add so you won't call me a racist for liking that joke, my Pharmacists are both Indian. One man and one woman. The woman has a red dot. Both of them are top notch and very professional. They even call the house to make sure any new medication I'm prescribed is working okay.

auctionwatch Wrote:

....and just what race would an India Indian be???? I want to be up to par on my bigotry references..............we all have to excel at something........

Mike, thanks I understand it better now. I would agree, it would get much less notice if it is at the Federal level.

Richard, It's a little more complicated than that, but that's basically it in a nutshell.