How do they sleep?

January 28, 2009, 4:42 PM UTC
Fortune

paperYou’ll have to excuse me this morning. I’m very annoyed. Last night when I got home from work I received another communication from the insurance company that handles medical for my corporation. They’re very, very good at communicating, this insurance company. What they’re really not very good at is ever paying a single nickle in benefits to policy holders, at least without a knock-down, drag-out fight.

I can honestly say that for every check they send out, they produce ten other mailings – excuses, requests for additional information, reports on excuses and, of course, rationalizations.

Yesterday it was a long document demanding more information on my wife, who has been covered by company benefits for many years now. All of a sudden, guess what. They don’t seem to know who she is. Where does she live? Where was she born? Does she have secondary insurance? No explanation is given for this institutional amnesia, but I can think of one: she filed a number of dental claims a few weeks ago. This latest salvo is designed to put off the inevitable (insufficient) payout for a few weeks or, if somebody very skilled it on the desk in Connecticut, months.

At the same time, I was informed that my 5 AM visit to my local Emergency Room last fall was being denied because the ER physician was out of network and, you know what, it wasn’t an emergency anyway. This was surprising to me, considering how many really scary tests they gave me before they felt comfortable to send me home. I’m fine now. But I certainly wasn’t fine then. I think if a person is admitted to the ER, kept there for six hours and only released after certain terrifying tests came back clean, they had an emergency.

What kind of people make these decisions? And if somebody were to throw them out of a window, would their injuries be covered?