Is using an insurance company website portal a good idea?
In my opinion, “No”. I’ve been told that insurers have placed tracking software in the program that follows your computer wherever you go. On the other hand, there are certain things that can only be obtained from the portals, such as W-2s. My objection to website portals is that insureds become obsessed with them and actually go there up to 20 times a day in order to feel calm and safe about their claims. Not realizing that these portals are not generally kept up to date, the information you get from it is either going to calm you down, or scare you to death. Visiting website portals everyday is NOT a best practice. I can’t tell you how many denial letters have crossed my desk from non-clients who were told, “We noticed you visited the website frequently and our medical reviewers have determined that because you can do that you are able to work. In my opinion, communicating by regular mail is a much safer option for your claim.
My doctor and I communicate through email. Is this a good idea?
Definitely not.Communicating with your doctor using email,(especially with a concierge doctor) means that all of the emails are discoverable in a court of law. I object to it because email is less formal, and people tend to say things via email they normally wouldn’t say face to face. Usually family information is often shared with a treating physician via email, such as, “Our family went hiking last weekend and I am really hurting today. Can you refill my prescription?” All of these emails become part of your patient file, which the insurance company will have access to eventually. Just one mention such as the above will send Prudential over the cliff to claim denial. A brief comment of, “I’m doing so much better!”, can be used to support a denial. Therefore, it is not a best practice to communicate with treating physicians by email, or even TeleHealth. I’d stick to the the “old” method of sitting in an office face-to-face and letting the doctor document the consultation.
Who can I complain to if my insurer is unfair, or, is conducting an unfair review of my claim?
Those claimants with ERISA Employer Group Claims can write a letter of complaint (I prefer to position this as a request for assistance) to their regional EBSA, the Employee Benefits Security Administration, the regional arm of the U.S. Department of Labor. Don’t expect much, though. I’m told by attorneys that the EBSA doesn’t do anything until such time as the claim is denied, and of course, we don’t want that. However, I do find that filing complaints does have its benefit in numbers. If a lot of claimants file complaints eventually they may actually have to deal with some of the issues. Of course, claimants may file “internal complaints”, but don’t expect much help there either. You will only receive a letter from the insurer outlining what they’ve already done and saying “THEY DID NOTHING WRONG.” So, once again there’s little help there.
For the IDI folks with a state jurisdiction, filing complaints with the state Department of Insurance could be helpful in some cases. If a lot of people began filing complaints against Unum, for example, again the DOI may have to so something. Internal complaints can be filed, but insurers don’t pay much attention to them. What I find usually happens with internal complaints is that although they will never admit to any wrongdoing, they silently fix the problem.
I encourage people to file complaints and get the circumstances in the record. People aren’t doing that much anymore, but they sure used to.
For the ERISA folks, I often notify the DOI even when they don’t have jurisdiction on the claim “just for informational purposes.” Having complaints on record can’t hurt.Finally, IDI claimants should be aware of what the “Unfair Settlement Claims Practices Acts” are in their state and file complaints that one or more have been violated. These Acts are largely based on the NAIC Model Acts (National Association of Insurance Commissioners) adopted by all of the states. The NAIC Model Acts lack enforcement laws, but violations of the Unfair Settlement Practices Acts can be serious. The Model Acts are where most of the “best practices” for claim review come from. You can find these for each state on the Internet.
According to the Maine DOI the Unum Settlement Practices Acts are still in force and insureds can complain if Unum violated any of the conditions of the settlement. There is also an RSA (Regulatory Settlement Amendment) requiring Unum to “consider” the decisions of treating physicians.
Please note that not all insurance companies have “complaint departments.” Don’t be surprised if your complaint is answered by the same person you’re complaining about.
If you have any questions about this please feel free to contact me at: DCS@metrocast.net
