Assurant Health ripoff, lying, uncaring, to appeal a claim is a waste of time Milwaukee Wisconsin

In report #196917, Jill tells the story of her suffering at the hands of Assurant Health. She was diagnosed with an especially difficult brain tumor, and the only surgeon who could treat it was "out-of-network" for her insurer.

I have won forty-two lifesaving insurance appeals -- one for myself, and forty-one for other patients. All different insurers, all over the country. These treatments cost from $150,000 to $500,000. All of them were either out-of-network, or deemed "experimental/investigational/not medically necessary" by the insurance companies. I won the majority of these appeals in one week or less.

I have never lost a case.

In order to help Jill, and all of your other frustrated insured people, I first have to explain what went wrong with her case.

1. The health insurer is not a social service agency, it is not their job to care. Fighting an insurance company is a strategy game. We win a strategy game by going into it from a position of strength, by always being alert to our opponent's weak points, and by keeping a cool head. We don't win the high stakes chess game by begging, pleading, and bringing emotions into it.

It is simply the insurer's job not to pay, and YOUR job to make them pay.


2. Jill spent three hours on the phone, begging and pleading with the insurance company. The real decision-makers at insurance companies will not be accessible to you by phone. You are wasting your time. I have a saying, "The only reason to talk to your insurer is to find out where to write to."

Who is really standing in the way of your treatment? Who has the power to approve it? The Medical Director of your insurance company. Obviously, Medical Directors do not like to be found by the likes of you and me. You are going to have to search for their names, titles, mailing addresses ... and especially their fax numbers. I have found hundreds of Medical Directors, you can do it, too.

Then, you are going to have to PUT DOWN THE PHONE, and start researching and writing your appeal.


3. They tried to send Jill to an in-network doctor who was unqualified to do her surgery. I deal with this speed bump upfront. When a patient asks me to help them to get to an out-of-network surgeon, I say, "Find out first who they would like to send you to IN the network."

I then google that unqualified in-network surgeon, and read his resume. I find out exactly how unqualified he is. Then, I search the NCI PubMed database of medical journal articles, and see what papers he has published. If he has not published one paper about this type of brain tumor, I include the list of his publications, and type the words "No Articles about Acromegaly" across the top.

I then do the same for my out-of-network surgeon of choice. I prove that he has published three hundred peer-reviewed journal articles about acromegaly surgery. I include a complete list of his two hundred articles, and complete text copies of the best ones.

Next, I join every online support group for acromegaly that I can find. Yahoo groups, websites, listservs ... all of them. I join, introduce myself and do what I call "calling out for precedent." In other words, I ask, "I need out-of-network surgery for acromegaly with Dr. Expert. Did your insurance pay for it? What is your name, insurance company, date of surgery, and your exact diagnosis?"

If what you are seeking is a legitimate medical treatment, I guarantee that your insurer has paid for it hundreds of times before -- yes, even if they say that it is "experimental." It is up to you to find at least a half-dozen times when they have paid for it ... this list of precedent will also go into your written appeal.


4. Proceed to write down your "bad medical story" -- all of the things that the in-network doctors did wrong in your case. All of the tests that they misread, all of the wrong surgeries you received, all of the wrong advice that they gave you. Do not complain about these mistakes, or make any editorial comment about them. Just innocently report them, as though you are catching your addressee up on your case.


5. Spend at least eight hours finding exactly the right decision-makers at the insurance company to send your appeal to. If you address your appeal to the Insurance Commissioner, lawyers, politicians, Oprah, or Michael Moore ... they will know that you just fell off the turnip truck, and you will be easily defeated.

I address my appeals to the Medical Director, with copies to the CEO of the insurance company, a couple of likely Vice Presidents (such as VP of Healthcare Operations), the President of the appropriate state's Medical Society ... and a few other choice individuals. Then, I show my carbon copy list on the cover page of the appeal -- for maximum intimidation.


6. The purpose of a written appeal is not to educate. Remember, your insurer has already paid for this treatment hundreds of times. The purpose of the winning appeal is to INTIMIDATE.


People think that an appeal is a two-page pleading letter. That is a losing appeal. My appeals these days are 80+ pages long. Blizzards of official-looking paper, mountains of proof.

I get to say all this because, back in 2005, I was diagnosed with a late-stage cancer, and given months to live. The oncologist said to me, "There is no treatment for your disease. And, even if there were, they wouldn't pay for it."

I stayed cool, I gathered my proof, I spent two months preparing a 23-page appeal document. It took my insurer two days to decide to pay for a fourteen-hour abdominal surgery, intraperitoneal chemotherapy, and a lengthy hospitalization. All of the treatment was out-of-network, and I had no out-of-network benefit. I made them pay it all, I received treatment from the world's expert in my cancer, and I am in perfect health three years later.

One of the commenters suggested suing the insurance company. Good luck with that. Lawyers aren't interested in denial of care cases. These cases are impossible to win in a court of law, and there is no money in them -- all you get is your treatment. Besides, the insurance company is not intimidated by your little lawsuit -- they have a hundred lawyers to your one lawyer.

The insurer is not intimidated by you HIRING a lawyer. They are intimidated by you writing such a strong, professional, powerful appeal that they suspect that you might BE a lawyer.

Put down the phone, start your research, prepare a blockbuster written appeal -- full of proof, totally professional. Purge your appeal of all emotion, particularly anger. The minute you give in to emotion, you have lost your case.

Yes, it is work. It takes me 12-20 hours to prepare a winning appeal. You are new to this, so it may take you forty hours to write a winning appeal document.

Is your life worth forty hours of work? Is your life savings worth forty hours of work?

Do what I say, and they will pay. Every time.


Laurie Todd
The Insurance Warrior

Find a lawyer that handles medical and sue them, do not settle and do not sign a nondisclosure clause. The scum need to be punished for playing with folks lives and emotions over a dollar bill. Beware of healthmarkets, mega life and health too, they prey on folks worse than assurant does.

Find a lawyer that handles medical and sue them, do not settle and do not sign a nondisclosure clause. The scum need to be punished for playing with folks lives and emotions over a dollar bill. Beware of healthmarkets, mega life and health too, they prey on folks worse than assurant does.

Find a lawyer that handles medical and sue them, do not settle and do not sign a nondisclosure clause. The scum need to be punished for playing with folks lives and emotions over a dollar bill. Beware of healthmarkets, mega life and health too, they prey on folks worse than assurant does.

Find a lawyer that handles medical and sue them, do not settle and do not sign a nondisclosure clause. The scum need to be punished for playing with folks lives and emotions over a dollar bill. Beware of healthmarkets, mega life and health too, they prey on folks worse than assurant does.

Like I said in the previous statment you have an extra $1000.00 out of network deductible plus and addition $10 k out of pocket ...hey thats 11k I think I was right on the money. Yes I do understand that there is a seperate bill for the surgery and hospital stay, and $17000.00 is still low for a surgeons bill, at least by the standards of the state I am in. I guess the size if the malformation and the location could have a lot to do with the amount of the bill.

Ok now onto the network questions. With assurant you can pretty much chose your network. Most of the time if you use and agent he should go over your network choices. Assurant can not change the network on their own for you,thats against the law . You have to give the the authorization to do that. You signed up for the plan it must have been the plan that you wanted...what right do they have to just go change it for any reason. Now if you would have dont your part and contacted your agent or at least the insurance company you could have gotten a list of providers. I make sure that every client that I have has a list of doctors and hospitals that take thier network.I also make sure that if any client has any problems to contact me not the insurance company first. It is in my best interests to keep my clients informed and happy.

Next the premium difference of $8.00 a month for a different network is just a drop in the bucket as far as commisions or rates for the insurance company. It is your agents responsiblility to make sure you have a solid network of doctors and hospitals in a reasonable distance to treat any condition that might come up.

An employee of Assurant health said that my statements did not make any sence. First of all you spell it sense, and I can assure you that every single statement I made is true and accurate. In regards to the surgery, the surgeon charged $17,000 for his service, this does not include the hospital billing, I still have the copy of the EOB showing that Assurant paid him $1400.00 towards this amount. I found it outrageous also. This is still a very touchy subject when people ask me about my experience, since my original posting about 2 years later I called and got one of their phone in agents and he asked me to tell him my story. When I did, he apologized and asked why they didn't just switch my network to one that the hospital was in, my comment was, you mean they can do that, he said yes, so he then told me that the hospital in question was in 7 of their networks, he told me to check and see if a particular one included my local doctors also, so to make a long story short, I did and called him back the next day. He then switched my network to one that included the hospital. This gentleman was a honest part of this insurance company, too bad that all the other 20 or so people couldn't find it in themselves to let me know that it was a possible option and that this other network was actually cheaper than the first one I was in. About $80 per month cheaper in premiums and now I don't have all the out of pocket extras for out of network up to $9000 per year that I've be paying for. Since switching I call before every appointment to make sure that the doctors and physicians are in network and I've still had some problems that I've had to contest before finally getting them to pay. To make a long story short why didn't one of those people tell me that my network could be changed? Which I've always had a PPO and I do know the difference between the two. Because then I wouldn't have had all that out of pocket for out of network services or all the worry that I had about my family having to come up with that amount in such a short time. All in all, I believe it was because Assurant Health would end up having to pay more and they don't care about their policy holders. Maybe they don't do this to everyone in your opinion, but they did do it to me. And as far as the $10,000 max per person, I'm looking at a EOB right now and it says that I've spent $1,000 towards my deductible remaining 0, network out of pocket spent $2,000 remaining 0, non network deductible spent 0 remaining $1,000, non-network OOP YTD 2,000 remaining $9,000. If you take $2,000 plus $9,000 the last time I checked it is $11,000 that is above what you say their max is and I can assure you that is what they charge me so your info is wrong.

There is somthing that could be smelly with this post. First off I have had back surgeries where the surgeons bill is $70,000.00. How could a complicated brain surgery only cost $17,000.00 . My surgery the bill totalled $180 k Assurant has a $1000.00 penalty for leaving the network with a max out of pocket of 10k. I did a little homework for oklahoma and the usual and costumary charge for a brain surgery to remove a tumor on the low side was 42K just for the surgeons bill. Second assurant or any ppo policies thru any company that I work with do not require refferals to see specialist. HMO policies require refferals but assurant does not sell hmo's. My guess is you most likley do not know what kind of policy that you have let alone what the coverages accually are. I would love to give a stab at helping you to see what I can get done.I would need to know what plan you have.
What your deductible is and your policy number. Post a responce back here and I will get you my email address to get the proper information from you.

Insurance agents are licensed by their state(s) to protect and educate consumers as they help them navigate the complexities of their health plan. I strongly agree that their agent should be their advocate and should be there to help especially in a time of need. It should be a relationship.

My heart goes out to this policyholder. She was getting the run-around at the home office of Assurant and was forced to make decisions without the assistance of an agent. At a time when she is dealing with the emotions of a serious illness, the company she trusted is pointing fingers in every other direction.

An Assurant agent mentioned the $25K check he could have put in her hand...after insulting the victim and stating that she should have read the policy. My guess is that he has never actually read the policy section that describes the conditions that must be met before that benefit is payable. It sounds good to "sell" that feature, but read the fine print. It has to be a metastatic spread of cancer. She would have had to wait until the disease progressed before getting that wonderful $25K...can't use that from the grave. It is in the brochure and his manager pumps him up to "sell" it that way, but the actual policy is different. The big print giveth, the small print taketh away...

MD Andersen, one of the top cancer hospitals in the nation should not be an out-of-network facility and she should have had the ability to self-refer if she were on a PPO. What network is Assurant using if a customer can't go to the top cancer hospital in the nation? God forbid if you have to use their choice on an organ transplant...it might just be a van in Mexico...

I think that agent has an idealistic approach and unfortunately, he is in for a rough ride with Assurant as his carrier. Sounds like his customers are already calling, hopefully just the little issues like unpaid doctor visit charges. It won't be long until his eyes are opened...hopefully, it doesn't take one of his customers getting hurt like Jill.

Of course, if the commissions are good, we can always throw it back on the fact that she should have read the policy and move on to the next victim. Cash that commission check, next! General Agencies make 34%+ of your monthly/annual premiums with Assurant. They offer the highest commissions in the market and their agencies get paid upfront as soon as the policy is issued. So if you purchase a policy for your family that is $5000 per year, the agency is getting $1700 as soon as your policy is delivered. Because the agent is paid up-front, the level of service he provides is actually below par at best. Need an example, pay your children for their chores a year in advance before they actually do them...

If you are a consumer that purchased an Assurant policy, I hope you went out to the front yard to wave goodbye to the agent as he drove off, it will be the last time you see him...if you purchased over the phone, you probably are dealing with a call center that has 75 sharks working the phones to sell, but no customer service department...great hold music though...

In purchasing any health plan, make sure that the agent provides a full, written outline of the coverage and takes the time to explain the good, the bad and the ugly. Many carriers are notorious for hidden access fees, policy limits and/or caps, high coinsurance percentages and restrictions on simple things like preventative care. Many plans have multiple moving parts and layers of risk. Use Jill's story to ask the right questions in advance...I am sure that is why she wrote it. Get your answers in writing...

Unfortunately, we find that many agents in the health industry to "gloss over" those details when trying to "sell" a policy. With the high commission rates and upfront advances that companies like Assurant offer, it can attract the "used car salesmen" of the insurance industry. Also be careful of these add-on features that promise to provide a $25K check in your hand if you experience a devastating health issue. Read the fine print and don't trust the agent. Get the answers in writing.

Finally, check up on the carrier. With the ease of gathering information and consumer reports, you will see that carriers like Mega Health and Assurant are being exposed.

Insurance agents are licensed by their state(s) to protect and educate consumers as they help them navigate the complexities of their health plan. I strongly agree that their agent should be their advocate and should be there to help especially in a time of need. It should be a relationship.

My heart goes out to this policyholder. She was getting the run-around at the home office of Assurant and was forced to make decisions without the assistance of an agent. At a time when she is dealing with the emotions of a serious illness, the company she trusted is pointing fingers in every other direction.

An Assurant agent mentioned the $25K check he could have put in her hand...after insulting the victim and stating that she should have read the policy. My guess is that he has never actually read the policy section that describes the conditions that must be met before that benefit is payable. It sounds good to "sell" that feature, but read the fine print. It has to be a metastatic spread of cancer. She would have had to wait until the disease progressed before getting that wonderful $25K...can't use that from the grave. It is in the brochure and his manager pumps him up to "sell" it that way, but the actual policy is different. The big print giveth, the small print taketh away...

MD Andersen, one of the top cancer hospitals in the nation should not be an out-of-network facility and she should have had the ability to self-refer if she were on a PPO. What network is Assurant using if a customer can't go to the top cancer hospital in the nation? God forbid if you have to use their choice on an organ transplant...it might just be a van in Mexico...

I think that agent has an idealistic approach and unfortunately, he is in for a rough ride with Assurant as his carrier. Sounds like his customers are already calling, hopefully just the little issues like unpaid doctor visit charges. It won't be long until his eyes are opened...hopefully, it doesn't take one of his customers getting hurt like Jill.

Of course, if the commissions are good, we can always throw it back on the fact that she should have read the policy and move on to the next victim. Cash that commission check, next! General Agencies make 34%+ of your monthly/annual premiums with Assurant. They offer the highest commissions in the market and their agencies get paid upfront as soon as the policy is issued. So if you purchase a policy for your family that is $5000 per year, the agency is getting $1700 as soon as your policy is delivered. Because the agent is paid up-front, the level of service he provides is actually below par at best. Need an example, pay your children for their chores a year in advance before they actually do them...

If you are a consumer that purchased an Assurant policy, I hope you went out to the front yard to wave goodbye to the agent as he drove off, it will be the last time you see him...if you purchased over the phone, you probably are dealing with a call center that has 75 sharks working the phones to sell, but no customer service department...great hold music though...

In purchasing any health plan, make sure that the agent provides a full, written outline of the coverage and takes the time to explain the good, the bad and the ugly. Many carriers are notorious for hidden access fees, policy limits and/or caps, high coinsurance percentages and restrictions on simple things like preventative care. Many plans have multiple moving parts and layers of risk. Use Jill's story to ask the right questions in advance...I am sure that is why she wrote it. Get your answers in writing...

Unfortunately, we find that many agents in the health industry to "gloss over" those details when trying to "sell" a policy. With the high commission rates and upfront advances that companies like Assurant offer, it can attract the "used car salesmen" of the insurance industry. Also be careful of these add-on features that promise to provide a $25K check in your hand if you experience a devastating health issue. Read the fine print and don't trust the agent. Get the answers in writing.

Finally, check up on the carrier. With the ease of gathering information and consumer reports, you will see that carriers like Mega Health and Assurant are being exposed.

Insurance agents are licensed by their state(s) to protect and educate consumers as they help them navigate the complexities of their health plan. I strongly agree that their agent should be their advocate and should be there to help especially in a time of need. It should be a relationship.

My heart goes out to this policyholder. She was getting the run-around at the home office of Assurant and was forced to make decisions without the assistance of an agent. At a time when she is dealing with the emotions of a serious illness, the company she trusted is pointing fingers in every other direction.

An Assurant agent mentioned the $25K check he could have put in her hand...after insulting the victim and stating that she should have read the policy. My guess is that he has never actually read the policy section that describes the conditions that must be met before that benefit is payable. It sounds good to "sell" that feature, but read the fine print. It has to be a metastatic spread of cancer. She would have had to wait until the disease progressed before getting that wonderful $25K...can't use that from the grave. It is in the brochure and his manager pumps him up to "sell" it that way, but the actual policy is different. The big print giveth, the small print taketh away...

MD Andersen, one of the top cancer hospitals in the nation should not be an out-of-network facility and she should have had the ability to self-refer if she were on a PPO. What network is Assurant using if a customer can't go to the top cancer hospital in the nation? God forbid if you have to use their choice on an organ transplant...it might just be a van in Mexico...

I think that agent has an idealistic approach and unfortunately, he is in for a rough ride with Assurant as his carrier. Sounds like his customers are already calling, hopefully just the little issues like unpaid doctor visit charges. It won't be long until his eyes are opened...hopefully, it doesn't take one of his customers getting hurt like Jill.

Of course, if the commissions are good, we can always throw it back on the fact that she should have read the policy and move on to the next victim. Cash that commission check, next! General Agencies make 34%+ of your monthly/annual premiums with Assurant. They offer the highest commissions in the market and their agencies get paid upfront as soon as the policy is issued. So if you purchase a policy for your family that is $5000 per year, the agency is getting $1700 as soon as your policy is delivered. Because the agent is paid up-front, the level of service he provides is actually below par at best. Need an example, pay your children for their chores a year in advance before they actually do them...

If you are a consumer that purchased an Assurant policy, I hope you went out to the front yard to wave goodbye to the agent as he drove off, it will be the last time you see him...if you purchased over the phone, you probably are dealing with a call center that has 75 sharks working the phones to sell, but no customer service department...great hold music though...

In purchasing any health plan, make sure that the agent provides a full, written outline of the coverage and takes the time to explain the good, the bad and the ugly. Many carriers are notorious for hidden access fees, policy limits and/or caps, high coinsurance percentages and restrictions on simple things like preventative care. Many plans have multiple moving parts and layers of risk. Use Jill's story to ask the right questions in advance...I am sure that is why she wrote it. Get your answers in writing...

Unfortunately, we find that many agents in the health industry to "gloss over" those details when trying to "sell" a policy. With the high commission rates and upfront advances that companies like Assurant offer, it can attract the "used car salesmen" of the insurance industry. Also be careful of these add-on features that promise to provide a $25K check in your hand if you experience a devastating health issue. Read the fine print and don't trust the agent. Get the answers in writing.

Finally, check up on the carrier. With the ease of gathering information and consumer reports, you will see that carriers like Mega Health and Assurant are being exposed.

GTL or of New York has a high deductible catastrophic policy if you qualify.

The deductible is 25 - 50K but pays 100% to 1 million.

need more info call me or visist our agancy website

CLICK here to see why Rip-off Report, as a matter of policy, deleted either a phone number, link or e-mail address from this Report.

The benefit organ transplant thru assurant is the maximum life time amount on your policy. The only time it goes below that is if you go to a non designated transplant facility. I.e. go down to mexico and get the surgery done in the back of a mini van. If you want the policy details sent to you i will gladly send them for you. Just leave me a message on here.

That is great that you recommend the cancer benefit option on top of all of your Fortis/ Assurant/ Time plans to make up for what Fortis lacks in cancer coverage. What supliment do you recommend to assist with organ transplants as I see on most Fortis policies a lifetime maximum of $100,000 toward organ transplants. My mother-in-law exceeded $1,000,000 for a lung transplant this year. How does anybody protect themselves from a claim that large? I see that most policies have a specific lifetime max on organ transplants between $100,000 - $500,000. Seems a bit too low.

First, I am very sorry to hear about your misfortune. I notice you never mentioned working with your agent or representative, so I assume you did not use him/her as a resource.

Almost without exception, this type of thing happens because the consumer, in this case the insured, has absolutely no clue about their coverage and assumes there will be no problems. I am an independent rep for Fortis (now Assurant) and actually have one of their policies. What I see time and time again is people complain about how much they have to pay, so they compromise on benefits to get a lower premium, and then without fail when they have a claim it is all the big bad insurance company's fault. Yes, there are unethical agents out there, but with this exception, if you purchase a policy without understanding exactly what it is you are getting, then you have no basis to complain. People put more effort into buying a car than they do purchasing insurance.

Were you fully aware of how a PPO works and what your out of network coverage was? If not, then why?

Would you handle a complex legal case on your own? probably not. You would engage the services of a professional. People in these situations always think everything is covered. I make sure my clients know exactly what they are getting, Review potential scenarios such as the one you described and what the coverage would be, and most importantly offer supplemental coverages to handle things that are not covered under the health policy, and insist they call me first before they have any procedure done. Health insurance is simply financial protection, nothing more. I would have reviewed your out of network benefits, and recommended a supplemental plan that would have had a check for $25K in your hand within a week as you would have qualified for this benefit based on details you provided. (you choose the amount when you get the policy)

So, to all of you who think insurance agents are unethical and avoid them like the plague, you are in for a surprise when you need someone on your side in a situation like this. I have had some complaints from my clients about Fortis (now Assurant) recently and am working on this for them. I provide this at no cost as this is what I promised when we put the policy into place.

Buyer beware, and there is a good chance at some point in your life that an insurance representative will be your best friend.