Not only are disability companies giving claimants problems, but health insurers and hospitals are as well. Several instances have come to my attention when patients complained that their health insurance purchased from the “Health Marketplace”, specifically CIGNA, was denying basic diagnostic procedures such as MRIs and CAT scans.
The “Healthcare Marketplace” always was an expensive type of insurance available to those too young to receive Medicare. COBRA is also very expensive due to the 42% charge employers make to keep employees on their health care premium lists. The interim period between no Madicare and age 65 is where other health insurers zero in with high premiums (no subsidy) and denials for expensive procedures.
Patients pending surgeries complain that since their “new tests” are not approved, surgery is postponed and won’t be performed either. This leaves patients/insureds hunting for new doctors, new insurance and countless delays while CIGNA, for example, saves money by denying basis diagnostic services.
CIGNA isn’t the only problem. Hospitals, too, are rejecting patient surgeries to be conducted by the wrong surgeons etc. so as not to disturb the success rate of the hospital. Therefore, surgical patients are forced to search for hospitals that are willing to perform surgeries at all.
In the disability claims world insurance companies are maxing out on their level of incompetence. New York Life, for example, didn’t know what ERISA was, and was’t aware that claimants are entitled to a copy of their Administrative Record when claims are denied. Geesh! I had to argue the point after requesting a copy of the file for my client. Although I’ve been writing about how the file management systems have changed, it seems to me that insureds really aren’t listening. (If you ARE, then I apologize) Copies of actual Plans and policies are so hard to find, I double whether claims handlers actually know which Plan or policy they are adjudicating at one one time.
Bottom line, since “Marketplace health policies are not employer related, they aren’t subject to ERISA. But, claimant can complain to their State Department of Insurance. And, I highly recommend that you do so.In addition, if you have other choices available to you from the Marketplace, I’d choose another company other than CIGNA, even if CIGNA is slightly less expensive.
