Group Health

Do you mind if I rant for a minute?

I realize that insurance companies are the scum of the earth and I also realize that health insurance is a giant scam, in general. HOWEVER, I am still shocked at just how out of control it is.

When I am paying to have secondary insurance, you darn well better cover those claims that my primary covers. Otherwise, what the heck am I paying for? An extra plastic card in my wallet? Ummm, no thank you.

My most recent gripe is with Group Health. In the past year they have decided that they reserve the right to not pay for my secondary coverage if they have not saved enough money by being my secondary rather than my primary. Confused? Yup, so was I.

Here’s how it works: If the bill is 75 dollars total, and my primary covers 50, and Group Health covers 25, then they’ve saved 25 dollars by being my secondary. That goes into a special ‘savings pot’. Now let’s say that the next claim they get would require that they cover $75 under normal circumstances. They can’t tell me that they would actually pay that claim in full because right now I only have $25 in my special ‘savings pot’. They may, but they also may not. And there’s 3 or 4 different things they have to factor, and it really depends on the situation. *eyeroll*

What kind of ridiculous scam is this? I have never had a secondary insurance provider process claims this way, but evidently it’s the new ‘in’ thing to screw us as consumers even more. Thanks, guys! Much appreciated.

So basically, I can never go to the doctor and not worry that my secondary won’t cover it. Imagine what that does to our buget sitting here waiting for the claim to process and to receive the bill and/or EOB only to then have to call and hash it out with Group Health. This is not why I have secondary! I have secondary so we don’t have to pay the remaining costs. So we don’t have to worry about getting the final bill and being surprised. Agghh!! This makes me want to rip my hair out.

At least now I know. After 6 phone calls to the Group Health’s customer service line, between me, Alex and the provider’s office. My final phone call on this claim was today, and I finally got a straight answer.

Can I also add that their customer service sucks? A lot! Every single person, other than the one I spoke to today, was terrible. So snarky and condescending and just plain rude. Either that or had no clue how to explain my benefits to me. Or, it was rude and stupid combined. The other really stupid part about their customer service is that the provider CSRs and the customer CSR’s don’t see the same information as far as call history. So my CSR today couldn’t see the notes from the provider’s phone call in order to explain to me why my provider keeps being told that none of my claims from them will be approved. Even though one of them now HAS been approved. Stupid, right?

I guess the moral to this story is: don’t EVER get Group Health if you can avoid it. Thank goodness that with Alex’s promotion, he was required to switch to a different health insurance provider. As of the end of August, I no longer have to deal with stupid Group Health BS.


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