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Report: #1170872

Complaint Review: Combined Insurance Co. - Nationwide

  • Submitted:
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  • Reported By: sucker — anytown Kansas
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  • Combined Insurance Co. Nationwide USA

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My husband was approached in his wood shop several years ago by a Combined Insurance Salesman, and talked into purchasing accident and disability policy. Of course, it was too good to be true. On May 14th I was involved in a car accident, the other driver crossed the center line and hit me head on, that sent me to the ER. I was told I was being admitted due to carotid artery possibly having a hemorage. I filed my claim in July as I missed a lot of work due to other injuries I had, and was put on restrictions by my PCP.

I received a check for $200 (ER benefit)and told that would settle my claim. My husband had called them previously and they told him we were covered for the hospital confinement, etc. portion of the policy. But, we were not based on a technicality. The hospital kept me overnight and admitted me to a room, filed out admit paperwork, etc., and Combined Insurance doesnt consider that to be a confinement. I was expecting to get a check for over 3500 dollars from Combined for all of my claims that should have been covered based on how the salesman sold the policy to us. He said we would be covered for any accident that left one of us unable to work..ha, not true. Not only that, but the first copy of our policy we received was in JUly of 2014. We should have had it back in 2009 when it was purchased, and never received it. My husband tried to get a copy of it once, and that's when they muddied the waters with him and signed me up on the policy as well, but we never got the policy so we could see what we really were covered for.

Just to be clear, I had to fill out a bunch of paperwork for them describing the injuries, the treatment I was receiving, etc, etc. But, it was up to me to follow thru making sure they paid attention to everything, basically I had to do their work for them. I still haven't been reimbursed for the physical therapy and when I called to ask about it, it ended up being MY Fault, BECAUSE I DIDN'T SEND THEM THE BILL FOR PHYSICAL THERAPY!!! I signed a release for them to get whatever they needed from the clinic and hospital...but, you know, thats not their job.

What I really loved about the customer service people is that they are trained to muddy the waters, this person actually had to nerve to tell me she was a consumer as well, and so she understood I was upset that I wasn't being reimbursed as I thought I would be. Unbelievable. Just pay the claim like we were told we would be paid, and there won't be any need to give me your false empathy.

So, you may have an accident, but you aren't covered unless you meet the criteria for being admitted to the hospital, and only then. no reimbursement allowed for missing work whatsoever!! Stay away from these pushy underhanded people. We have paid a monthly premium under false pretenses for many many years. What a waste of money, and what jerks.

This report was posted on Ripoff Report on 08/19/2014 03:25 PM and is a permanent record located here: https://www.ripoffreport.com/reports/combined-insurance-co/nationwide/combined-insurance-co-of-scranton-pennsylvania-misrepresented-policy-coverage-scranton-p-1170872. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year. Ripoff Report has an exclusive license to this report. It may not be copied without the written permission of Ripoff Report. READ: Foreign websites steal our content

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REBUTTALS & REPLIES:
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#5 Consumer Comment

You Muddied the waters

AUTHOR: AlwaysAskQuestions - ()

POSTED: Tuesday, October 21, 2014

Yes I went back and re-read your original posting. NO you did not say that you were only complaining that a salesman lied to you. In fact you never once said he lied, you only stated that:

"My husband was approached in his wood shop several years ago by a Combined Insurance Salesman, and talked into purchasing accident and disability policy. Of course, it was too good to be true."

Thats all you said about the original salesman. And you went on to make several more complaints about how you were paid, and that Combined asked you for the physical therapy billing so they could pay your claims, and that you did not receive a copy of your contract.   Then in your response to my original posint again you only made a comment that

"If you read the complaint again, you will see that it is really a complaint that the agent was untruthful about what the policy would provide for."

I have no idea which agent you are talking about, the one you spoke to on the phone, the first salesman, the second salesman.... 

Now you are claiming that your complaint is only that a salesman lied to you???  BUT your description of the events does not support that you were lied to.  Per your description you were told that being admitted/confined to the hospital would pay a certain amount. BUT the hospital did not bill for an inpatient stay or confinement. This is not the fault of Combined or the salesman.  They did not lie to you because you were not actually confined to the hospital.  The hospital confinement definition that Combined and every other insurance out there uses is defined by Medicare, and is the responsibility of the hospital to determine if they should bill for it.  Combined then has to process their claims according to that definition and billing.  So the only one lieing to you is you.  Thats because you refuse to acknowledge that someone other then you(and in this case, other then combined) defines what a confinement is. And when someone tries to explain it to you, you get defensive and arguementative and insist that YOUR way is the only way. 

And you are the only person here who cannot read.  I DO NOT OWN OR WORK FOR COMBINED.  I am simply looking into combined as I am considering purchasing.  I saw your complaint and figured I would explain why Combined did not pay you hospital claim against your inpatient benefits and why Combined would ask you for copies of bills from your physical therapy.  You spent more time explaining these things then you did on the salesman.  H***, you even spent more time complaining that the customer service was being nice to you then you did about the salesman.  So now for you to say that your only complaining about a salesman when you brought up in much greater detail several other topics means that you are the one muddying the waters here. Next time you post a complaint or call into any other customer service, or complain to anyone in general, that you stick to just what actually matters.

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#4 Consumer Comment

Muddy the waters

AUTHOR: JJ - ()

POSTED: Saturday, October 18, 2014

Again, you really didn't read the part about the salesman fibbing about what we were actually covered for, just to get us to buy the policy, did you? Try awknowledging that you are just mad because I am telling the truth about your company. I would think that you would be intelligent enough to figure out that 1. Saleman lied and said we were covered under the policy for accident and covered no matter what for recovery time, it didn't matter if we were admitted as a patient to the hospital or not. 2.

Obviously, the salesman knew he lied about it and that is why he didn't deliver the policy to us, and that is why the person on the phone at Combined said she would contact our salesman to deliver the policy. 3. The replacement saleperson complained to us about the first salesperson and said he would have to do some checking to find out about the policy but in the meantime, talked my husband into signing me on as well, yes, my husband is a sucker. The second salesperson also left the company, and we didn't receive the policy. 

Now, I don't give a hoot about your rendition of things, because you have no idea why I am mad, and you have proven that. You won't be a good owner either. Watch out America.

 

 

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#3 Consumer Comment

I know who you were complaining about

AUTHOR: AlwaysAskQuestions - ()

POSTED: Tuesday, October 14, 2014

I am investigating combined insurance as I am contemplating buying them. So yes I know you were complaining about combined. I felt the need to respond to your complaint because it is the same thing I hear our customers complain about everyday. You blame the insurance company for how your hospital billed something that causes your contract to operate differently then you think it should. Combined, or any insurance company for that matter, has zero control on how your hospital stay is billed. The only thing the company can do is process the claim according to your benefits. When you find you contract you will find that it does not define an inpatient stay because that is defined by Medicare.

Secondly, your policy, per your description, pays if you are admitted to the hospital on an inpatient basis. I was trying to explain to you that the hospital determines if you are inpatient or not Combined. This is not a technicality. Just because it makes you feel better to call it a technicality doesn't actually make it one. No insurance company would consider what you described as an inpatient stay because the hospital did not bill it as one. A technicality would be the insurance company looking for a loophole to not pay a legitimate claim. This was not a loophole, this was the hospital billed outpatient not inpatient and therefore Combined paid your outpatient benefit instead of you inpatient benefits as a result.

Thirdly, for your contract, I don't know how long ago you started with combined but I have found that at one time combined was giving the contracts to customers when they signed them up, before they left your home. Before that they had the salesmen hand deliver the policies when customers were approved. But in the past 10 to 15 years they have been mailing customers their contracts when approved. This is also another complaint I hear from customers daily, that we at BC/BS, did not give them copies of their contract.

MAYBE you did not get yours by some slim chance, but I have heard that excuse used so many time by people just trying to bolster their own claims, only to see them proven wrong every single time... Sorry but I am extremely cynical of any customers who make this claim because this is such a big deal for insurance companies. There are huge penalties for companies to not send you a contract, this is so heavily tracked by my own company because so many people make this claim to the department of insurance and we MUST show where it was sent when first issued and each and every time the customer requested it.

Forth, as for your responsibility on inpatient vs outpatient, what you describe as being your responsibility is way outside the norm BUT I know better then anyone that there are literally millions and millions of types of major medical plans. 99% or more will have a much higher copay or coinsurance then an outpatient stay. I myself have a $35 copay for outpatient visits in the hospital and $200 a day up to $1000 max copay for inpatient stays. That is the norm because the hospitals charge more for inpatient stays then they do for outpatient stays.

I'm not trying to insult your intelligence here. I am just trying to go e you a little more knowledge to show you that you weren't scammed,you just did mot receive what you expected because you were not aware how complicated medical billing is and how it affects your insurance. What you described happened to you as sounds to me like your contract was honored as it was written. And you are mad because you expected more because you thought the hospital admitted you when they actually did not. It the hospital told you that they were admitting you, then you really should be angry with them because their bills did not reflect what the told you.

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#2 Consumer Comment

Blue Cross and Blue Shield? This is for Combined Insurance

AUTHOR: JJ - ()

POSTED: Tuesday, October 14, 2014

First of all, are you sure you are responding to the correct post? You said you have worked hard at Blue Cross Blue Shield but this was a complaint against Combined Insurance. I had Blue Cross/Blue Shield Insurance and never had an issue with my claims, did receive my policy in the mail and was NEVER lied to by my agent. I no longer carry it, because back when we had this policy(over 10 years ago), they sent us a letter as soon as Sebilius held office and changed everything in Kansas about insurance, and told us they were raising our premium from $560 a month to $980 a month, and we had no claims except about 5 doctor visits for sick calls and no diagnosis of any long term health issues. We simply couldn't afford it anymore. Insurance at one time, actually did what it was meant to do, but greed changed all of that.

If you read the complaint again, you will see that it is really a complaint that the agent was untruthful about what the policy would provide for. As for not receiving the policy in the mail, it wasn't received and a phone call was made to the company, who said they would contact the salesperson who sold the policy. The salesperson who sold the policy quit so another salesperson came to the shop to visit with my husband who talked him into signing me up on the policy and apologized that the policy had never been sent. So, try keeping your opinions in check, cause you were wrong. Another detail, when this agent signed me onto the policy he signed me up as the policy holder, so now I am the original policy holder and that is not what should have happened, my husband is the original policy holder. But, you are so smart, they could never screw up, right? So, when my husband called to visit with them about the policy the first time, they answered all his questions but the second time, said he wasn't the policy holder and they couldn't speak with him about the claims...hmmmmmm. Guess that salesperson didn't fill out the paperwork correctly or some idiot in the office screwed up.

We aren't stupid, responder, we never received the policy, and several calls had been made. In the course of the past 7 years, my husband moved his shop location and called to tell them so, but still, no policy and then he gave up trying or forgot to keep calling to do something that should have been taken care of long ago BY COMBINED INSURANCE.

As for the technicality, I can call it whatever I like, because that is what it is. Actually being admitted as an outpatient is more costly to me as a consumer because the insurance carrier won't write off as much of the claim as they would if I were an inpatient, thus the balance falls on my shoulders...do your homework. I am the one who is paying the hospital last time I checked, not you. What are you, 30 years old or something? I'ver been around a lot longer and I wouldn't be searching a way to find out about Combined Insurances lack of integrity and complain if I didn't have a valid complaint. I hope to keep others from making the same mistake so they can find quality accident and disability insurance.

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#1 Consumer Comment

Medical billing is complicated

AUTHOR: AlwaysAskQuestions - ()

POSTED: Saturday, October 11, 2014

Did the hospital bill as inpatient or outpatient?  Based on your description the hospital kept you overnight but did not bill as an inpatient stay.  An inpatient stay is typically when you stay 24 hours or more.  This is standard medical billing practice and not a "technicallity".  Now I assume that you have major medical insurance and with your medical insurance you have a higher copay or coinsurance on an inpatient stay then on an outpatient stay.  Which means you had less out of pocket expense with your medical insurance, which is in your favor. Unfortunately this is now working against you in your accident insurance as they pay inpatient stays at higher amounts then outpatient stays.  It was your hospital that determined how to bill and your insurances are applying your benefits according to that bill. This is standard billing practices that are practiced throughout the United States. Combined did not muddy anything here, its just how the American medical billing system works.

As for combined asking for your physical therapy bills from you.  YES you signed a HIPAA release form allowing Combined to REQUEST the details from your therapist or hospital or where ever BUT that does not guarentee that the hospital or therapist will respond.  Your therapist or hospital my require additional authnorization from you, they may simply ignore the request, the address you proved may have been wrong.  They request the bills from you because your therapist/hospital CANNOT ignore your requests.  But they have no vested interest is responding to Combined and infact they have more legitimate reasons not to respond then to respond.  So to be mad as Combined for them asking you to supply copies of bills that you probably already received is unreasonable.

As for your contract.... I refuse to believe that you did not receive a copy of it.  Chances are you either misplaced it or threw it out thinking it was junk mail.  It is a MAJOR violation of federal insurance law for them to not mail you a copy of your contract when you sign up for it.  If I remember correctly, they had to mail a copy of your contract to you within 5 to7 days of when your application was approved.  Combined has been in business for over 90 years. If they were not sending out contacts to their customers they would have been closed down decades ago by the federal government.  

I have worked for Blue Cross and Blue Shield for over 12 years in their claims department and customer service.  We worked hard to PAY your claims. It is standard practice in any insurance company to do everything they can, short of taking your word for it, to pay claims. And why don't they take your word for it??? Would you take my word for it if I said you owe me $5000 because I say that your child broke my window?  Of course not. You want proof.  You want details. You want to know why is that window worth $5000, and you probably want proof that it was your child that broke it.  The same holds true for any insurance company. 

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