Dadgum
11-13-2006, 12:20
:mad: Golden Rule Insurance :mad:
Trust me. You don't want to go anywhere near Golden Rule Insurance. This was a major medical policy with a $2500 deductible, then expenses were covered 100% after that. I signed up for this plan after extensive discussions with Golden Rule reps.
Now, I am not arguing about the legal behavior here, I'm talking about ethical. They have a detailed policy write-up, which I readily admit I skimmed for the coverage that I anticipated I might need. I did not read it in depth. I will be paying for this for months.
Apparently, there are 6 things that aren't covered within the first 6 months of your policy. Lucky me, a hernia (which I got in VT) is on the list.:mad: What did that mean? That the company was unwilling to apply ANY expenses related to the hernia toward my deductible.
Here my chief problem was that the doctor couldn't determine whether it was, in fact, a hernia, or whether it was something else (it didn't push in and out). The doctor told me that I should get a CT scan done. moreover, that I should have both an Abdominal and a Pelvic CT scan because it was in the umbilical region. So the TWO CT Scans were being used to diagnose the problem.
At first contact and at second, the company rejected my claim that these should be applied toward my $2500 deductible. This amounted to $1900. Finally, after much persistence (and help from a local surgical unit's billing department), they agreed to put it toward my deductible. Well, Golden Rule decided that since it was a "Secondary Network" that they would reduce the amount of the covered ("put toward deductible") expenses to $1400. So now I felt I was looking at having to pay up to another $1100 for the impending surgery (which I've been told will cost somewhere around $10k).
I received a notice in the mail saying that $1400 had been applied to my $5000 "out of network deductible." Again, after calling the company, and verifying my policy, I find out that not only do they reduce the covered expenses (notice how in one case they call it a "Secondary Network" and in the other they call it "out-of-network"), but they have DOUBLED my expected deductible AND by calling it my "out of network" deductible they are now telling me that I currently have applied $0.00 toward my "in-network" deductible.
What does all of this mean? That now I am going to have to pay in addition to the $1900 + Surgical consult fees that they wouldn't consider, I am going to end up spending between $2500-$3500 MORE depending upon whether the facility is in their network.
Again, I'm not saying that they are doing something illegal... because as it turns out they have a number of things stated in the policy that I did not know (my own fault). I am saying that they dealt with me in an unethical manner. The operator I spoke with today said that whenever they discuss benefits, they say "benefits may be reduced in out of network providers." Apparently that means... "don't go out of network or Golden Rule is going to screw you over." Don't you think that I would have gone to a different medical facility (with a HERNIA?) if it meant saving myself $2000? Of course I would have. And they know it too. Which is why when I called from VT to ask about coverage, they kept mum on the subject.
As ticked as I am that I didn't do a better job of reading the policy, I honestly believe that Golden Rule enjoys playing semantic games that in the end will screw you over. If you are looking for a short-term insurance major medical policy... I highly recommend looking past Golden Rule.:mad:
Trust me. You don't want to go anywhere near Golden Rule Insurance. This was a major medical policy with a $2500 deductible, then expenses were covered 100% after that. I signed up for this plan after extensive discussions with Golden Rule reps.
Now, I am not arguing about the legal behavior here, I'm talking about ethical. They have a detailed policy write-up, which I readily admit I skimmed for the coverage that I anticipated I might need. I did not read it in depth. I will be paying for this for months.
Apparently, there are 6 things that aren't covered within the first 6 months of your policy. Lucky me, a hernia (which I got in VT) is on the list.:mad: What did that mean? That the company was unwilling to apply ANY expenses related to the hernia toward my deductible.
Here my chief problem was that the doctor couldn't determine whether it was, in fact, a hernia, or whether it was something else (it didn't push in and out). The doctor told me that I should get a CT scan done. moreover, that I should have both an Abdominal and a Pelvic CT scan because it was in the umbilical region. So the TWO CT Scans were being used to diagnose the problem.
At first contact and at second, the company rejected my claim that these should be applied toward my $2500 deductible. This amounted to $1900. Finally, after much persistence (and help from a local surgical unit's billing department), they agreed to put it toward my deductible. Well, Golden Rule decided that since it was a "Secondary Network" that they would reduce the amount of the covered ("put toward deductible") expenses to $1400. So now I felt I was looking at having to pay up to another $1100 for the impending surgery (which I've been told will cost somewhere around $10k).
I received a notice in the mail saying that $1400 had been applied to my $5000 "out of network deductible." Again, after calling the company, and verifying my policy, I find out that not only do they reduce the covered expenses (notice how in one case they call it a "Secondary Network" and in the other they call it "out-of-network"), but they have DOUBLED my expected deductible AND by calling it my "out of network" deductible they are now telling me that I currently have applied $0.00 toward my "in-network" deductible.
What does all of this mean? That now I am going to have to pay in addition to the $1900 + Surgical consult fees that they wouldn't consider, I am going to end up spending between $2500-$3500 MORE depending upon whether the facility is in their network.
Again, I'm not saying that they are doing something illegal... because as it turns out they have a number of things stated in the policy that I did not know (my own fault). I am saying that they dealt with me in an unethical manner. The operator I spoke with today said that whenever they discuss benefits, they say "benefits may be reduced in out of network providers." Apparently that means... "don't go out of network or Golden Rule is going to screw you over." Don't you think that I would have gone to a different medical facility (with a HERNIA?) if it meant saving myself $2000? Of course I would have. And they know it too. Which is why when I called from VT to ask about coverage, they kept mum on the subject.
As ticked as I am that I didn't do a better job of reading the policy, I honestly believe that Golden Rule enjoys playing semantic games that in the end will screw you over. If you are looking for a short-term insurance major medical policy... I highly recommend looking past Golden Rule.:mad: