re: How many of you have truly been screwed over by an insurance company?

Just the opposite actually. We lost a ton of shingles during Delta and had two small water spots on our ceiling. Adjuster came out, took some pictures, etc. Ended up with a check for $9,300. My roofer did my whole roof for $4,800 and I painted the ceilings myself.

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The graph is from acute care claims for the ACA policies for two states in a sinlge year.

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Post acute care claims, not acute care. And I am heavily involved in that sector. Although in retrospect, that version of that graph is poorly labeled. There’s a senate report admonishing them for the practice.

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Just curious would you prefer single payer??

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Absolutely not. The closest things we have to model the single payer system options would probably be the VA, Medicare, or your state’s Medicaid program. All have some good things about them. All of them have negatives that far outweigh the benefits (in order, wild inefficiency with poor availability, poor reimbursement to providers for services rendered and confusing, no out of pocket maximums without supplemental insurance in a vulnerable population (does a lot of things right but confusing to navigate and requires a lot of understanding to use right), varies state by state so hard to give a definitive drawback, but it’s generally an “everything is free” with very low reimbursements to everyone who accepts it. The patient are generally entitled and want “free” medicine or equipment when alternatives are adequate and very cheap)


I’d rather fee for service with a transparent pricing model, money due up front (or payment plan discussed up front. I’m not a monster), file the claim on the patient’s behalf and insurance reimburse patients directly, much like the Oklahoma Surgery Center model or how most of it was done in the 90s. I still have some colleagues (subspecialists) practice this way.

I've seen a dental plan that between employer and employee pay costs $1200 per year but only covers $1000.

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Post acute care claims, not acute care. And I am heavily involved in that sector. Although in retrospect, that version of that graph is poorly labeled. There’s a senate report admonishing them for the practice.

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That’s where the data comes from.

And the senate report was regarding prior authorization and denials of which UHC is nowhere near the worst offender.

Ida storm damage. Insurance company required to make a written offer by 30 days. On the last day, they sent letter finding my damage was $50 less than the deductible. My true damage was $269,000. I had to sue and the company went into receivership. I was left with accepting less like thousands of others who were insured by companies that went into receivership.

Only issue I had was after Ida when my insurance company said they weren't paying Loss of Use, then asked me to submit receipts because they now were paying Loss of Use, then after paying me demanded the money back because in fact they weren't paying Loss of Use.

I'd already used the money to payoff the credit card I used for evacuation expenses, so they tried to take the money out of my claim to fix the hurricane damage on my house.

It was a huge battle that finally was resolved in my favor. But afterwards, they treated me like I tricked them or something.

As far as roof claims go, don’t try to go against the insurance yourself, especially right now. Find a reputable contractor that comes recommended by people you trust. Just because has the big dollars to put themself in front of your face constantly doesn’t mean they are great. Use recommendations.

Have the contractor meet the adjuster. Approved? Great! Denied? Your contractor SHOULD know the next steps to take to argue the denial.