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- #11
- 10,276
And that is the truth!!!
Assurant Near The Top...as Expected...
- Thread starter CHUMPS FROM OXFORD
- Start date
If you look at the linked report, or any other for that matter, you will see most of the issues stem from complaints.
84% of the COMPLAINTS in the OH report were claim related.
52% were claim denial.
On the surface, it would appear that carriers are just willy-nilly denying claims for the heck of it.
Of course that would be stupid on their part.
My experience would indicated the overwhelming majority of the time a claim is denied it is justified. Has to be in the high 90's. I am hard pressed to think of a time when a claim was denied unjustly.
Interestingly, the complaint ratio was derived by dividing the number of complaints into the premium. A more relavent figure might be number of complaints per 1000 insureds.
As for Mega (and UA, another limited benefit plan), my guess would be the carrier does a better job of explaining why the claim was denied or reduced than plans with other carriers. These are complaints lodged with the state, not the carrier. Going to the DOI is kind of a last resort kind of thing.
Complaint: My doctor charges $100 for an office visit but you only paid $30.
Mega: Yes, look on page 2 of your policy and you will see that we only pay $30. You lose. Be glad it wasn't a big claim.
84% of the COMPLAINTS in the OH report were claim related.
52% were claim denial.
On the surface, it would appear that carriers are just willy-nilly denying claims for the heck of it.
Of course that would be stupid on their part.
My experience would indicated the overwhelming majority of the time a claim is denied it is justified. Has to be in the high 90's. I am hard pressed to think of a time when a claim was denied unjustly.
Interestingly, the complaint ratio was derived by dividing the number of complaints into the premium. A more relavent figure might be number of complaints per 1000 insureds.
As for Mega (and UA, another limited benefit plan), my guess would be the carrier does a better job of explaining why the claim was denied or reduced than plans with other carriers. These are complaints lodged with the state, not the carrier. Going to the DOI is kind of a last resort kind of thing.
Complaint: My doctor charges $100 for an office visit but you only paid $30.
Mega: Yes, look on page 2 of your policy and you will see that we only pay $30. You lose. Be glad it wasn't a big claim.
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- 14,808
Back in the days when carriers really messed with claims - very good reading. Can read a lot of chapters online but nice insight into how some carriers used to handle claims.
Making a Killing - HMOs and the Threat to Your Health click "read it."
Making a Killing - HMOs and the Threat to Your Health click "read it."
InsCandy
New Member
Is Community- American Community? There are very competitive in OH!
Good Selling!
Good Selling!
- Thread starter
- #15
- 10,276
Yes...that is them.
- 148
I discovered while working for them (my mistake) that their complaint ratios are not listed with individual health policies because all of their policies are association group.
If you look at group policy complaints you will find the true story on MEGA.
The only policies of theirs that appear on individual are life policies with accelerated death benefit which puts a few into the individual health catergory.
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