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What are my rights with my insurance company?

btkuhn — Fri, 23 Oct 2009 12:02:45 -0800

What are my rights with my insurance company? You are not my lawyer, but...

I am not looking for a legal opinion, but I'd like to find out what my rights are in a situation, and I don't know how. I have insurance coverage through my job with a major national insurer. I had to go for a long-term residential stay in the hospital to take care of some health problems. I knew that it was going to be expensive before going in, so I contacted my insurance company to make sure that the treatment was covered and at what rate it was covered. I was told that yes, the treatment was covered, and it was covered at 70% until my out-of-pocket max of $3000/year was reached.

So, after going through the treatment and getting my bill, I saw that it was covered as it should have been, except that when my out-of-pocket max was reached nothing different happened - I wasn't cut off at $3000 responsibility. I contacted my insurance co and was told that I must have been told the wrong thing before going in, and the type of treatment I underwent had no out of pocket max restrictions - ie I was responsible for 30% of the total cost, which works out to be about 35%.

I've had problems with insurance companies in the past, so I made sure to get written confirmation of my responsibility before going in for treatment. I have two email from customer service saying that my liability was capped at $3000, for the specific treatment I went for. I went through the appeals process with my insurance company and showed them these emails, and my appeals were denied, with no explanation except "sorry, you were told the wrong thing". I am currently appealing through my state insurance commission but I've heard things move very, very slowly.

My question is, what are my rights in this situation, legally? It seems pretty straightforward - the insurance company told me a treatment was covered, and then after I had it done they changed their tune and won't cover it. So they should be forced to pay for what they said they would. But I don't know how the law really works - perhaps insurance companies are allowed to lie to you (maybe customer service communications aren't legally binding), all that matters is the text of the policy itself? It turns out that the policy itself does not have a out of pocket max for this kind of treatment - this is written in the fine print of the 100+ page policy book, which I didn't have at the time of my treatment. All I had access to was a condensed policy booklet that did not mention this exclusion.

Can anyone comment on what my actual rights are in this situation, if any?

Is there any way to estimate what a car & car insurance would cost me if I moved to San Francisco?

scazza — Tue, 20 Oct 2009 12:16:16 -0800

What are ways to estimate what a car and car insurance would cost me if I moved to San Francisco? I'm looking for what it would cost to have a reasonable, eco-friendly (not necessarily a hybrid, probably not a hybrid) car for 2 people in San Francisco. Something like a hatchback that's 1-2 years old. I live in NYC now so I have no idea how to go about estimating insurance and car loan payments. Resources? Thanks!

(There is a question about this from 2005, but I think things may have changed by now.)

Dental Insurance Waiting Period Details

stewiethegreat — Fri, 07 Aug 2009 11:14:54 -0800

Another Dental Insurance Question: My Delta Dental starts on Sept. 1st, but they won't cover fillings until Mar. 1. What happens if I have a filling done before Mar. 1? Obviously, they're not going to cover it, but would I still be able to get Delta's negotiated rate with my dentist? Would Delta pay the dentist and then invoice me to reimburse them? Would I be making life unreasonably difficult for my dentist if I did it this way?

Thanks!

Please help me reclaim my car.

otis24 — Fri, 20 Feb 2009 19:53:49 -0800

How do I get my car back? It's still in my ex'es name. I've been giving her $$ for insurance and have been making the payments on it since 2003. I live across the country now and she ignores all my requests to do anything about transferring the title/policy, etc. Here's the situation:
Back in 2003, my then girlfriend leased a 2003 Honda Civic for me (this is in CT). The car was in her name because my credit was really bad. This car is and was always intended to be mine (it's a manual; she doesn't even know how to drive stick). I drove the car for several years and I always made the lease payments, as well as the maintenance and insurance payments (which is in her name; I am listed on her plan). When we broke up, around 2005, we never really officially talked about what would happen with the car. I continued to make the payments, sending Honda checks to Honda, and insurance checks to my ex. I have the account numbers, but no access to the account information.

When we knew the lease was about to expire, my ex offered to 'purchase' the car in her name, but I would continue to own/use/pay for it. It had really low miles and seemed like a good deal. We went down and filled out the paperwork, which I have. The insurance policy remained the same; in her name, but I am listed on it.

Six months later, in 2008, I moved across the country, to California. I quickly settled in with a good job and girlfriend. I drive 100 miles/day for work. I never intended to drive this much, but all is good otherwise. However, my car is not registered in CA (it is current in CT). I also do not technically own this car. Nor do I even know how much I owe on it. I am still on good terms with the ex, but she blatantly ignores any and all attempts to get information about the car, or do what it takes to transfer ownership. To be honest, I don't even know what needs to be done, or what my best course of action is. Additionally, this situation has caused a lot of stress and worry between my girlfriend and I over the last year.

What do I need to do to get my car in my name, legally, in California?

Please hope me, President Obama

Anonymous — Tue, 27 Jan 2009 18:03:56 -0800

NoInsuranceFilter: I awoke New Years Day in the hospital. My clothes had been cut off, I had a catheter in and a wrist restraint on my left wrist. I had five stitches in my eyebrow. The bill has arrived. Out with a friend, drinking and apparently got ahead of myself. Said friend was concerned with other things and claims to have not noticed my state. He says that he recalls seeing someone steal my shoulder bag off my prone body after I was struck and fell to the sidewalk head first but claims to have been more concerned with the blood coming from my head. I lost a digital camera and my passport along with numerous objects and papers gathered during years living abroad. Despite his claim at having been concerned with my safety, I awoke six hours later alone in the hospital. He wasn't so concerned to have even gone to the hospital with me. I called him and asked him to please pick me up when the hospital indicated it was time for me to go and he called back and asked if I could find anyone else to get me.

Now, the bill has arrived.

Blood bank - $137.00
Emergency - $18,637.50
Pharmacy - $218.00
IV Solutions - $116.00
Pulm Func - $86.00
Drug/Detail Code - $682.00
CT Scan - $24,379.00
Speech Therapy - $307.00
Radiology - $1015.50
IV Therapy - $636.00
Clinical Labs - $2700.50
Clinic - $25.00
Total: $48,940

I was in the emergency room from ~0230 until ~1130. The UC hospital even sent a small blue envelope so I could send my remittance.

I've contacted the county and asked for assistance. I'm a late-30's full-time community college student preparing to transfer. I receive financial aid and pick up occasional daily work as a consultant. On paper, I don't have a job.

I meet with the California county tomorrow and wonder what they will be looking for on my bank statement? The depression I felt after taking a beating, losing personal and valuable possessions along with losing a friend was beat back a bit with the purchase of an LCD TV made before the bill arrived. While I spent less than $500 should I be concerned with the county representative line-itemizing my most recent expenses? I haven't made any withdrawals and am not hiding monies. Should I hide expenses? My checking and savings are less than $600, combined. I just received a $1000 financial aid check but it won't be on my current statement. It is earmarked for the next two months rent.

I own a car but it is registered non-op. My possessions worth noting are the car, my bike, a bed, the tv and my laptop.

Finally, a professor suggested writing to my representatives both locally and nationally regarding the ridiculousness of this bill. Should I bother?

If I've left anything relevant out, I can be emailed at fortyeightnineforty@gmail.com

Realllllly Bad Situation

symbollocks — Mon, 27 Oct 2008 18:35:55 -0800

My friend needs suggestions and advice for a bad situation he's in. His dad has a compressed vertebrate and is dealing with a lot of pain. In trying to deal with his pain he has become addicted to (prescription) narcotics. He can only walk with the aid of a cane. He works at a news station.

His mother has a sciatic nerve problem and a compressed vertebrate. She too is in a lot of pain and takes a lot of narcotics to deal with it, though she is not addicted, she is still out of it for much of the day. She works as a nurse at a local community center. She too can barely walk, except with the aid of a walker.

My friend is 21, he is living at home and helping his parents as much as he can. He is unemployed, after being fired from a food service job and being forced to sell off his car after it broke down for good. He has a suspended license, and has 6 tickets for driving with a suspended license. The next time he gets pulled over for that the consequences are greater than a mere ticket, possible arrest or more.

He would like to get a job so he can help more, but it's hard to get one when the phone is often disconnected. That and he does not have reliable transportation, as his parents have only two cars, one of which is about to be broken down for good.

His parents have a lot of pets, which they are (for the most part) unable to take care of themselves, due to their health problems. He has to take care of these pets.

They are currently heating their house with 3 space heaters, and had previously been using the oven, which is now shot.

They will most likely be getting evicted sometime in the next few months due to financial problems. Their financial problems are primarily due to their health problems. They have health insurance, but it does not cover very much.

There is often no food in the house for days at a time. I subsidized them recently with a box of dumpstered bagels, after they had gone for 3 days without food.

What solutions exist for a guy in a horrible situation like this? or for his parents? Anything, even just to stabilize the situation.

He has given me permission to post this question and I can provide feedback if there are further questions.

Oh, and please, no pity comments. He's got a truckload of that stuff already.

Job-loss Mortgage Insurance?

JPowers — Wed, 04 Jun 2008 12:05:11 -0800

Should I get job-loss mortgage insurance? I've got a GREAT job, have no plans to ever leave or get fired, but for peace of mind, should I get insurance that will pay my mortgage for me if I ever run into an extended period of unemployment? My question is more along the lines of "is this type of insurance generally considered a waste of money?" Specific company/plan suggestions would be great as well.

HSA's = tax-free retirement account?

MrBCID — Wed, 16 May 2007 17:21:06 -0800

Health Savings Accounts (HSA's) ... Can they be used as just another tax-free retirement account after you max out your Roth IRA? I usually max out my Roth IRA and contribute to a 401(k) ... I just came across this Newsweek article that got me thinking about opening an HSA.
I used to contribute to a Flexible Spending Account and understand that the money in an FSA is lost if not used within a year...
An HSA on the other hand would let me keep that money in there kind of like a Roth IRA correct?
Do I have to be enrolled in a High Deductible Health Insurance policy to be eligible?

I am 22 years old and don't need my medical insurance for anything more than a yearly check-up.

Any advice would be really helpful. Thanks in advance.

When a tree falls in the woods, does the insurance company punish you?

10ch — Tue, 24 Apr 2007 06:48:48 -0800

At what dollar amount do I draw the line for making a homeowners insurance claim? We had a very large tree fall last week. It caused some damage to the house and the tree had to be cut up and dealt with. All in all it'll come in around two grand for repairs, should I claim it on my insurance?

So far the answers/anecdotes I've heard from people are all over the place. Some say it's not worth it to claim anything below ten grand. Others say claim if it's above your deductible (as low as $250!). I've heard of the "three strikes" rule and about the national databases that count even queries against you. It all sounds like a nightmare.

I want to be able to draw some sort of line. Should I claim if it's above a thousand? Five thousand? Ten thousand? Personal anecdotes, especially if they deal with life post-similar-sized claim, are welcome.

If it matters: I live in North Carolina and can pay cash for the repairs (though dropping two grand is wince-worthy).

I have $50K from insurance proceeds but I'm on SSI/Medicaid, what should I do??

pikaboy202 — Tue, 06 Mar 2007 08:23:13 -0800

What can I do to continue recieivng SSI and Medicaid benefits if I received a lump sum insurance proceeds? I know someone who's elderly and disabled. She is receiving SSI benefits and is on Medicaid. Recently, her husband was involved in an auto accident and he died. The other person involved was wrong and their insurance company paid out a wrongful death benefit to the wife in the amount of $50K.

She has the check but hasn't cashed it yet because she's afraid that it'll make her lose her SSI and/or Medicaid benefits.

I know of 2 options: spend down the money or put it into a "pooled trust." I know the drawbacks of a pooled trust is that you have no control over the dispursement of funds and also, after the death of the wife, the funds are used to payback medicaid.

My questions to the hive are:
1. If she spends down, what would be the best ways to spend down the funds? What should she do with the money to maximize usage (either for her or her beneficiaries when she dies) and also not jeopardize her SSI or medicaid benefits?

2. Would the pooled trust be a better option?

3. Are there any other ingenious ways to shield the $50K?

Term life assurance - flat payments or "inflation adjusted" payments ?

southof40 — Sun, 18 Feb 2007 18:12:44 -0800

I'm considering buying term life assurance for a term of 19 years. The default deal is $x per month for $z of cover (the amount of cover does not alter over time). However (this amazes me but it's true) the Company gets to determine $x on a year to year basis. You can also pay for the same cover by a different means in which your payments are a fixed number of dollars, $y, every month for the duration of the cover. The quote I have makes $x = $y/2.54 (obviously based upon the inital value of $x). The term is 19 years. Assume for the moment that $x truly is related to inflation. How can I calculate the rate of inflaction which is assumed by these two deals ? Just realised this sounds horribly like a homework question - if only it was ! Help me understand whether a larger flat-rate premium for life cover makes more sense than a smaller variable rate premium .

A question about home contents insurance in the UK.

Anonymous — Fri, 27 Oct 2006 10:21:19 -0800

A question about home contents insurance in the UK. It's suddenly become apparent that we're paying far too much for our home contents insurance and need to change. Although obviously can't post too many details (which is why I'm being anon), I was wondering if anyone could offer advice about changing and were to look for the best deals.

The real sticking point seems to be security -- premiums seem to be very high -- despite the fact we live in very secure housing - two intercoms and another ringable door before even getting to the front door and we live thirteen floors up in a tower block which makes the traditional methods of breaking in almost impossible.

It's the other unexpecteds and unmentionables that we're really interested in -- our current provider currently has a freezer clause that says we need to lose a hundred pounds worth on an accidental defrost before they'll pay out and there's an upper cap of £250 which seems wrong to me.

Any ideas?

What should I do with ym insurance settlement?

SweetJesus — Tue, 08 Aug 2006 07:34:19 -0800

What should I do with my insurance settlement money? I got hit by a hit-and-run driver about two years ago, and I've finally settled with my own insurance company for somewhere around ~80,000.

I'm 24, I've got very little debt, and very little idea about what to do with this money besides some nebulous idea about "investing" it. If you had 80,000 fall into your lap, what would you do?

Flood Insurance Question

space2k — Fri, 14 Apr 2006 12:35:48 -0800

My house recently flooded. Fortunately, we have flood insurance. Our adjuster claimed that we needed to remove our floors (hardwood and tile) throughout the house and replace. Our contractor (who I trust) said that's not necessary, that only re-finishing is required. Because of the discrepancy, I stand to pocket a chunk of change on the deal. The contractors are finishing up, and sure enough, I've received an insurance check that covers the work the adjuster described. The check has to be co-signed by my mortgage lender, who I've spoken to and says that they will simply endorse and send back to me. Then, it's mine to deposit.

I know of only one catch: If my home floods again and we haven't done the work the adjuster paid for, they won't pay for it again. Frankly, that's a risk I'm willing to take. The area hasn't flooded like this in the 50+ years since it was developed, and the cash I stand to make is 5 figures.

This must have happened to someone else out there - do I have any legal, tax or other worries that I haven't thought of?

I got the job! Now, what?

fletchmuy — Thu, 08 Dec 2005 09:43:20 -0800

So, I was just offered a job. It's a 12 month contract that will be going perm in the next year. So, first order of business is to find health insurance. Help me find the best option for me. Since I've never been a contractor, I don't know where to start. I am currently a full time employee with the company I've been with for the past 4 years. I'm married with no kids and we live in Georgia. My wife has her own business (no employees) and her business is set up as an LLC. Up until now, she's been listed under my health insurance plan at work. Should we set something up under her business? I know we can't do a group plan, but maybe a flexible spending account or something like that? Oh yeah, I should also add that we are actively trying to have kids, so a pregnancy in the next year is a real possibility.

Also, are there any other financial benefits or pitfalls to being a contractor that I should be thinking about?

I'll be contacting our accountant today to talk about this, but wanted to ask here first.

Thanks!

Pet insurance - scam or great???

joshgray — Wed, 21 Sep 2005 07:53:38 -0800

My vet friend totally loves pet insurance, but i've heard from some owners that they think it's a scam and we would be better off just putting the money aside. What is your experience? (my details inside) Our situation is we just got our first dog of our own, a 1 year old female black lab. I make decent $$ in IT, and the g/f is in school for about another year or two. I can cover normal expected expenses just fine while she's in school (and we're still single income), but anything major would be a problem - hence looking into insurance. We plan to be very active with her (running, hiking, etc) too if that up's the 'unexpected accident' percentage.

So i assume people will say it's worth it... Do you suggest a certain company or a certain plan of that companies (looks like each one has multiple levels covering all different things) THANKS!

When my insurance (COBRA) ends in March, what can I do?

konolia — Sat, 13 Dec 2003 10:45:31 -0800

When my insurance (COBRA) ends in March, what can I do? Private insurance is prohibitively expensive, and chances are with my preexisting health problems I may not be able to get insurance at all. Worst part is my monthly prescriptions are extremely expensive-we are talking the price of a car payment here, if not more.
Any suggestions, besides moving to Canada?