I never really liked our insurance company....we had to switch plans for the 3rd time in 9 years. Our last plan cost us 12k a year for our personal family coverage no dental or eye stuff included, Gman paid 1/2 of the plan cost for each of his 3 employees too.
Our co pay on the old plan and the plan before that was $20.00 for Dr visits, prescriptions were $5-$10. We did not need a referral to see a specialist.
This new plan sucks, as far as I am concerned. Our co pay is $30 for a visit to our primary, and $50.00 for a specialist. A specialist is a dermatologist, gyn-o, podiatrist, etc., and $250 for an emergency room visit. But it is the prescription portion of the plan the really irks me.
We can not get more then a 30 day supply of meds from our local pharmacy. G man has to order through an online pharmacy if he wants a 90 day supply. The old plan allowed him to get the 90 day supply at a savings from our local pharmacy, which was more convenient and comforting. Not so with this new plan. Having a face to face with the Pharmacist is the way I like to do business, especially when it comes to medicine. And if you forget to order online before your meds run out..hhahaha you are out of luck until the meds arrive...or you have to go to the local pharmacy, pay more, and only get a 30 day supply. That is if your prescription is still on file and is still active.
But what really torqued me has to do with Double G and his meds. In February he went to the local pharmacy and had to pay over $200.00 for his meds that cost only $70 on the old plan. (I forgot to check into the cost until today.) The insurance company told me his meds are a 3rd tier and the co pay is now $70 per med. Ok, I can accept that, after all the meds are for acne and not a life threatening disease. But why did he have to pay over $200? The customer service person informed me she could not discuss Double G's account with me, just provide general information, he has to give permission because he is over 18. Ok I can accept that too.
So I did a what if scenario: What if I paid over $200 for meds that I should have paid only $140 for, does the insurance company know I over paid and will the company send me a refund check? Her answer, yes the company would know I over paid, because the pharmacy submits all the paper work pertaining to the meds so the pharmacy can get paid, and NO the insurance company will not send a check until the patient files a claim. What if the customer does not know a written claim must be filed to receive the reimbursement? The customer will not get a check until the paper claim is filed.
This is how I see the non reimbursement scenario: The insurance company can legally steal from customers. And is morally and ethically corrupt. The reasoning for my opinion is that the insurance company is taking advantage of consumers that are not well educated with the sneaky workings of the medical insurance world. I do believe in personal accountability, but when someone, whether that someone is a company or an individual, has knowledge of a mistake by another, it is the first some one's responsibility to correct that mistake. Call me crazy, naive, living in a fanciful world, wearing rose colored glasses, or just plain honest, but that is what I believe and do.
ANALOGY: The bank teller, cashier, waitress, whom (who?) ever mistakenly gives me more money then I should get. I realize the mistake but do not return the money. That makes me a thief.
This is how I view the insurance company regarding their knowledge of over payment, but do not notify the customer. The company is a huge brick and mortar monster, lacking an identifiable head that contains a brain capable of thinking about the simply virtue of honesty.
The company as a whole is a factory manufacturing the ideal of .....Don't ask Don't tell. Deception and dishonesty. Legal theft.