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Insult to Injury - Disability Insurance Reform

    

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Insurance Type: long term disability
Insurer: Standard

After carrying me for 11 years for CFS, Standard just dropped me. as result, I am exhausting myself running around to more doctors and taking more tests -- all costs born by my health insurance company -- in order to reestablish disability for this lifelong illness that waxes and wanes. I'm one of the lucky ones as I have money to appeal and to sue.


Insurance Type: medical/dental
Insurer: Anthem Blue Cross and Blue Shield

My family has never needed to use insurance for emergency purposes until may of last year. My son was hit in the mouth by a baseball bat (complete accident) and knocked out several teeth and traumatized others. Anthem denied every single claim I sent them until I appealed and the claim went to the Office of Insurance of KY (an independent law firm...free service to me)

When this office reviewed the claims, Anthem had to pay. So up until now, they have paid for my son's implants (they weren't going to pay for temporary ones so we used permanent ones even though he was only 16) So now they paid for the implants but they just denied payment for the veneers to go on the implants! Explain that? Of course I will appeal and they will deny and then I will send it to the office of insurance and they should overturn this decision. We will not be with Anthem as of Oct 1.


Insurance Type: long term care
Insurer: traveler's/citi

My mom, is 85 years old. Although she lives on a modest fixed income, years ago she made a commitment to purchase long term health insurance to provide for nursing home care should the need arise. She scrimped over the years but has faithfully paid her $3400 policy and never had a claim.

Now she got a letter stating that premiums are going up and that to maintain her policy she needs to pay $4700 a year. Her other options are to drop the policy or to accept sharply reduced benefits. My mom was truly shocked to find herself in this predicament. Apparently somewhere in the small print of her policy, such huge price hikes are allowed? Where are the legislators who are supposed to be protecting senior citizens who tried to do only the right thing. This is truly a sham!



Insurance Type: Healthcare
Insurer: Blue Cross/Blue Shield Health Options

In 1997 I called my healthcare insurance provider, Blue Cross/Blue Shield for pre-approval on some medical testing to determine whether I had a sleep disorder. I was assured my coverage would pay for the testing. The testing was conducted over a series of four or five sessions and the bill came to around $10,000. When the claim was filed, Health Options denied the claim citing PRE-EXISTING CONDITION.

By their definition (which was detailed in the booklet they provided when I took out the policy through my employer) I didn't see how they could come to that conclusion. I had never been diagnosed with the condition, I had never been examined for the condition, I had never been treated for the condition, and had no clue that I even had the condition.


InsuranceType: group LTD disability
Insurer: Prudential Insurance Co of America

I have Fibromyalgia and am recovering from a craniotomy for Pituitary
Macroadenoma. I have severe symptoms from my Fibromyalgia and residual hormone deficiencies due to the brain tumor. Injury to my pituitary gland cause sight difficulties and inability to read or do computer work for more than a short time before I get bad headaches and widespread body pain from sitting at the computer. After 2 years of payment (which I obtained after 1 year of fighting Prudential) which I received when it was discovered that I had a brain tumor that would have to be removed via cutting through my skull. I lost some of my sight from the tumor and damage after the surgery caused me to continue to have difficulties. I have thyroid deficits and growth hormone deficits.

The former is now controlled but the latter has not yet begun to
come under control. I was awarded social security disability benefits with the minimal assistance of a non-attorney that Prudential hired to assist me with my claim. When, I received a favorable judgment from the Administrative Law Judge, without the need for a trial, Prudential cut off my supplemental payments which should have been reduced but not cut off completely. Prudential also started to demand repayment of the lump sum from SSD even though they were no longer paying my rightful benefits.

Isn't it funny that a large corporation hired someone to prove to the government that I am disabled then after award turns around and declares me not disabled for their policy. They even refuse to consider the Judge's opinions of the medical evidence that I provided without any help from the so-called legal assistance that they hired. I have sent Prudential all of the records provided to SSD. It is amazing that a Judge would declare sufficient "objective evidence" and Prudential claims there is none!!!!!

I've made three written requests for my claims file and any other pertinent information used in making their decision (January, April, and June)all 3 requests were ignored. Prudential claims nonreciept of the appeal I sent in January, even though I have confirmation of delivery to
Prudential's P.O. Box.

There are many other tricks and violations they have
put me thru.