I know that you are right - however this is exaclty what chaps me about the insurance companies -- they should consider ALL of the policies they sell as an aggregate and spread teh risk across ALL of them, not considering each individuals policy a single instance, and all of the GM employees as another single instance!
On 2/12/06, lee <[EMAIL PROTECTED]> wrote: > We're way off topic now, but I will go with it- > > I am now happily gone from the field of medical reimbursement, but I did work > in that field for nearly 20 years. For a year or so of that time I worked for > a TPA which provided individual health policies to the self-employed. What an > eye-opener! > > Such policies by their very nature are non-group and therefore the principle > of shared risk, the fundamental basis of insurance, is not in play. The > Insurer has to get more out of you than they pay, its that simple. > Consequently, these policies look dandy if you are reasonably healthy, but if > you get sick (I mean really sick, you have a heart attack, are diagnosed > with cancer, or diabetes, say) your insurance company is likely to reach into > its bag of dirty tricks to either rescind your coverage retroactively, > increase your rates to the point that you cannot pay them, issue a rider > excluding coverage for your conditon, or declare your condition to be > pre-existing or otherwise excluded under the policy. Failing those things, > the insurer may simply pend all of your claims for six months to a year > while they investigate to FIND OUT if they can do any of those things, with > the net effect that your bills don't get paid anyway until the investigation > is concluded, if ever. > > I'm not kidding. I worked in the Medical Investigations Unit and later worked > under the TPA's in-house counsel responding to Department of Insurance > complaints, and this is how the thing worked. If the bill was high enough, > they would even hire a PI to try and find a reason to deny the bills. > > Lee -- OK Don, KD5NRO Norman, OK '90 300D 243K, Rattled '87 300SDL 290K, Limo Lite, or blue car '81 240D 173K, Gramps, or yellow car '78 450SLC 67K, brown car '97 Ply Grand Voyager 78K Van Go
