Saturday, March 2, 2013

Insurance Companies – Modern Day Bandits

Insured – but No Pay!
It was during last winters stay at the Hot Springs that Bea encountered severe respiratory problems with pains in her chest. She asked me to drive here to the ER in El Centro. I got scared and was thinking the worst. It was already dark and because the bridge across the canal was closed we had to drive through the pitch-dark desert.

We had health insurance so the cost of whatever was coming our way would be covered – or so I thought. Bea was given all kinds of tests and it took 4hrs until she was released. The result was inconclusive as no medical reason could be found to be responsible for her problems. As we found out much later it was considered to be of psychological reasons or a panic attack.

After we got home we learned that the visit had racked up a bill of nearly $4000, which seems typical for the skyrocketing costs of U.S. health care. Anyway we were not worried – we had insurance so they would pay.



Yesterday, a full year later, we received a letter from the insurance company informing us that this claim was NOT eligible for payment. The reason given was that she was not HOSPITALIZED but only treated in the ER and that no medical reasons were detected.

Needless to say we were flabbergasted and deeply disappointed. After all, the same insurance company had just raised this winters premium with about 50%.

The question we’re asking ourselves now is how anybody could know or even suspect severe respiratory problems with chest pains to be of purely psychological reasons before seeking medical help. Also, it doesn’t seem clear that the diagnosis given that day was correct. At times Bea has had allergies and asthma-related problems.

Why I am writing this?

I think it should be a warning to all Canadian Snowbirds to really read the fine print and make sure that they have the right insurance company for the winter.

You are welcome to re-post this story anywhere you desire!


  1. Who was the insurance company? We had the opposite happen. We paid the deductible and they sent it back to us 6 months later. Ours was Manulife.

  2. How awful!! We were billed once three years after the treatment. We were shocked it hadn't been paid by the insurance company. However, the doctor didn't bill in the time period so we got stuck with it.

  3. Peter, My bill was over $7,000 - for ONE DAY. It will be interesting to see what the outcome will be insurance wise ! They do enjoy getting their high premiums but are often reluctant to PAY OUT !!

  4. Just another reason that we in Canada should be thankful this type of situation never occurs. If this had happened to your wife while at home our Medicare system would have handled it as routine without a penny of cost to you.

    I don't trust private insurance companies - never have! I'm even happy we have Government run auto insurance in B.C.

  5. Hey, I had similar symptoms a few years ago...respiratory problems and chest pains. Hubby took me to the ER and they connected me to an EEG. I could sit and watch my heartbeat spike. SOMETHING was happening...turns out, it was DEHYDRATION and the muscle which was being affected was my heart! Don't let those QUACKS tell your wife it was "nothing"! I was given IV fluids and sent home to rest and I was fine after that. But, here in the desert, dehydration can creep up on anybody and I've lived here 38 years!!! :-(

  6. That really sucks that they won't pay. Like you said modern day crooks.
    Read the fine print for sure.

  7. I have a suggestion that often works. Get in touch with the hospital and tell them that the treatment was not covered by your insurance. If they want to be paid, they need to resubmit your bill to the insurance company with a better explanation of the services rendered in the E. R. If you bug the hospital enough, they should be willing to put the correct billing code on their claim to the hospital. It is all a matter of communication by all three parties. You, the hospital and the insurance company. Good luck.

  8. Now you can say you have really experienced the United States. The insurance companies are always happy to take premiums but when it's time to pay out benefits they have a whole bunch of reasons not to pay that they never mentioned beforehand. And emergency rooms charge the earth because too many people use them and don't pay. An urgent care clinic or community clinic can be a better option if one is nearby and open when you need it.I hear that if a Medicare patient goes to the hospital they have to be very, very sure that they are being officially admitted. Otherwise they can be there 3-4 days under "observation". Medicare won't pay for "observation". So probably their supplemental insurance won't pay either. Standard insurance will agree to pay for a certain treatment and then when the bills start coming in they refuse to pay. A friend's husband had $300,000 back surgery that their very expensive health insurance refused to pay anything on. Luckily it was done at a university hospital and there was assistance from some foundation who helps patients who find themselves in such a situation. Insurance companies, the medical industry and the big pharmaceutical companies are all legalized thieves.

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  10. We had a medical emergency this past January. I called "One World' - the insurer for BCAA (British Columbia Automobile Association) as required. They approved my wife's visit to a medical facility. The medical facility billed our insurer directly for the fees. We were never handed an invoice for medical services. The bill went directly to our insurer.

    The attending physician strongly urged a follow up visit with an Ophthalmologist. I called 'One World' and they approved the claim for the specialist. We paid for that service - out of pocket - with the assurance (a claim number) that 'One World' will re-pay us. We have filed the required paper work and we are expecting a cheque from 'One World' upon our return back home in Canada.

    Several years back, the very same insurer had to deal with a serious case of food poisoning, suffered by one of my family members. The Visa came out and, before two hours, the bill was well over $3,000. The insurer (who had been advised in advance of the medical issue) approved the re-payment and we received a cheque to cover all out of pocket expenses. The insurer also evacuated our family member, by aircraft, back to Canada for further medical intervention. Again, we were insured through BCAA.

    There you have it. We have had two experiences with very good results. We can only hope you can settle your claim in a similar way. All the best on that front.

  11. Unfortunately, in the US, insurance cos deny a claim hoping you won't appeal. So do appeal. Then they very often deny the appeal betting that you won't sue because 9 out of 10 don't sue. So be that one who does. They nave nave a huge staff of lawyers with nothing else to do.

  12. Unfortunately, in the US, insurance cos deny a claim hoping you won't appeal. So do appeal. Then they very often deny the appeal betting that you won't sue because 9 out of 10 don't sue. So be that one who does. They nave nave a huge staff of lawyers with nothing else to do.


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