Trouble with company insurance - worth making a fuss about it?
A while back I started a new job at bigcorp. They insure all employees via some third party insurance company. We have a list of doctors we can go to, then either we pay there and can claim the amount from the insurance or we don't need to pay at all and insurance handles payment with the doctor.
When starting at bigcorp, we got a document that shows the inclusions/exclusions for the health insurance, also the limits (like, unlimited specialist visit but physiotherapy capped at XXX per year, etc). I had private health insurance before, so I know how the documents look, and the doc they gave us looked a bit short for a full insurance policy.
Anyway, without going in to too much detail, recently I handed in a claim to the insurance. I continued treatment, accumulated some more claims, added them in also.
After I already handed in my third claim for the same cause, all of them got rejected and insurance tells me that I should have done Y and Z before starting treatment but instead I did only Y so all claims are rejected.
As you can imagine, I referred to the "policy" document I got from my company and there it only says I should have done Y before starting treatment, no mention in the whole document of Z.
So to cut things short, after a few emails back and forth with the insurance they still insist I did it wrong, even though they also won't tell me any reference where the rule I apparently violated is stated.
For me it looks like there is another, larger set of rules that is not told to employees and that seems to cause rejecting claims. I heard similar stories from coworkers, although about smaller amounts.
I wonder what to do now, is it worth getting in touch with the people in HR that take care of insurance communication to make them aware of these things or do I look like a troublemaker?
I'm not looking for someone higher up in my company to "weigh in" on the insurance and pressure them to reimburse me, since I don't think that will work anyway, but I'm more thinking about providing feedback about my experience with the insurance (since bigcorp only recently contracted with said insurance.)
company-policy insurance
asked 49 mins ago
user97183
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A while back I started a new job at bigcorp. They insure all employees via some third party insurance company. We have a list of doctors we can go to, then either we pay there and can claim the amount from the insurance or we don't need to pay at all and insurance handles payment with the doctor.
When starting at bigcorp, we got a document that shows the inclusions/exclusions for the health insurance, also the limits (like, unlimited specialist visit but physiotherapy capped at XXX per year, etc). I had private health insurance before, so I know how the documents look, and the doc they gave us looked a bit short for a full insurance policy.
Anyway, without going in to too much detail, recently I handed in a claim to the insurance. I continued treatment, accumulated some more claims, added them in also.
After I already handed in my third claim for the same cause, all of them got rejected and insurance tells me that I should have done Y and Z before starting treatment but instead I did only Y so all claims are rejected.
As you can imagine, I referred to the "policy" document I got from my company and there it only says I should have done Y before starting treatment, no mention in the whole document of Z.
So to cut things short, after a few emails back and forth with the insurance they still insist I did it wrong, even though they also won't tell me any reference where the rule I apparently violated is stated.
For me it looks like there is another, larger set of rules that is not told to employees and that seems to cause rejecting claims. I heard similar stories from coworkers, although about smaller amounts.
I wonder what to do now, is it worth getting in touch with the people in HR that take care of insurance communication to make them aware of these things or do I look like a troublemaker?
I'm not looking for someone higher up in my company to "weigh in" on the insurance and pressure them to reimburse me, since I don't think that will work anyway, but I'm more thinking about providing feedback about my experience with the insurance (since bigcorp only recently contracted with said insurance.)
company-policy insurance
asked 49 mins ago
user97183
1
New contributor
user97183 is a new contributor to this site. Take care in asking for clarification, commenting, and answering.
Check out our Code of Conduct.
add a comment |
A while back I started a new job at bigcorp. They insure all employees via some third party insurance company. We have a list of doctors we can go to, then either we pay there and can claim the amount from the insurance or we don't need to pay at all and insurance handles payment with the doctor.
When starting at bigcorp, we got a document that shows the inclusions/exclusions for the health insurance, also the limits (like, unlimited specialist visit but physiotherapy capped at XXX per year, etc). I had private health insurance before, so I know how the documents look, and the doc they gave us looked a bit short for a full insurance policy.
Anyway, without going in to too much detail, recently I handed in a claim to the insurance. I continued treatment, accumulated some more claims, added them in also.
After I already handed in my third claim for the same cause, all of them got rejected and insurance tells me that I should have done Y and Z before starting treatment but instead I did only Y so all claims are rejected.
As you can imagine, I referred to the "policy" document I got from my company and there it only says I should have done Y before starting treatment, no mention in the whole document of Z.
So to cut things short, after a few emails back and forth with the insurance they still insist I did it wrong, even though they also won't tell me any reference where the rule I apparently violated is stated.
For me it looks like there is another, larger set of rules that is not told to employees and that seems to cause rejecting claims. I heard similar stories from coworkers, although about smaller amounts.
I wonder what to do now, is it worth getting in touch with the people in HR that take care of insurance communication to make them aware of these things or do I look like a troublemaker?
I'm not looking for someone higher up in my company to "weigh in" on the insurance and pressure them to reimburse me, since I don't think that will work anyway, but I'm more thinking about providing feedback about my experience with the insurance (since bigcorp only recently contracted with said insurance.)
company-policy insurance
asked 49 mins ago
user97183
1
New contributor
user97183 is a new contributor to this site. Take care in asking for clarification, commenting, and answering.
Check out our Code of Conduct.
A while back I started a new job at bigcorp. They insure all employees via some third party insurance company. We have a list of doctors we can go to, then either we pay there and can claim the amount from the insurance or we don't need to pay at all and insurance handles payment with the doctor.
When starting at bigcorp, we got a document that shows the inclusions/exclusions for the health insurance, also the limits (like, unlimited specialist visit but physiotherapy capped at XXX per year, etc). I had private health insurance before, so I know how the documents look, and the doc they gave us looked a bit short for a full insurance policy.
Anyway, without going in to too much detail, recently I handed in a claim to the insurance. I continued treatment, accumulated some more claims, added them in also.
After I already handed in my third claim for the same cause, all of them got rejected and insurance tells me that I should have done Y and Z before starting treatment but instead I did only Y so all claims are rejected.
As you can imagine, I referred to the "policy" document I got from my company and there it only says I should have done Y before starting treatment, no mention in the whole document of Z.
So to cut things short, after a few emails back and forth with the insurance they still insist I did it wrong, even though they also won't tell me any reference where the rule I apparently violated is stated.
For me it looks like there is another, larger set of rules that is not told to employees and that seems to cause rejecting claims. I heard similar stories from coworkers, although about smaller amounts.
I wonder what to do now, is it worth getting in touch with the people in HR that take care of insurance communication to make them aware of these things or do I look like a troublemaker?
I'm not looking for someone higher up in my company to "weigh in" on the insurance and pressure them to reimburse me, since I don't think that will work anyway, but I'm more thinking about providing feedback about my experience with the insurance (since bigcorp only recently contracted with said insurance.)
company-policy insurance
company-policy insurance
asked 49 mins ago
user97183
1
New contributor
user97183 is a new contributor to this site. Take care in asking for clarification, commenting, and answering.
Check out our Code of Conduct.
asked 49 mins ago
user97183
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user97183 is a new contributor to this site. Take care in asking for clarification, commenting, and answering.
Check out our Code of Conduct.
asked 49 mins ago
user97183
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user97183 is a new contributor to this site. Take care in asking for clarification, commenting, and answering.
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asked 49 mins ago
user97183
1
asked 49 mins ago
user97183
1
1
New contributor
user97183 is a new contributor to this site. Take care in asking for clarification, commenting, and answering.
Check out our Code of Conduct.
New contributor
user97183 is a new contributor to this site. Take care in asking for clarification, commenting, and answering.
Check out our Code of Conduct.
user97183 is a new contributor to this site. Take care in asking for clarification, commenting, and answering.
Check out our Code of Conduct.
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