Donna O'Donnell Figurski's Blog

It's All About Me!

Say It Ain’t So #2 Scars of Insurance Woes

Insurance woes – we all have them. It’s not right. We pay our premiums. We expect to receive service. But insurance companies don’t seem to play by the rules. Oh they want their money … and on time too. If you are late paying your bill, with no remorse, they will quickly cancel your coverage. Too bad! When you file a claim, you naturally expect that your insurance company will pay it in a timely manner. You would think so! So much time and effort is wasted by both the company and the client – the company trying to avoid paying claims – the client trying to attain their “just” due.

I often wonder how folks, the infirmed, the elderly, who have no advocate to fight insurance companies, get by. How often are folks simply worn down by the process? What about the folks who simply do not understand insurance-ese talk and can’t file a claim? Are insurance companies quietly squirreling their money away? That’s evil! That’s wrong! What a sorry state!

I have had a lifetime of insurance woes in the past seven years while dealing with claims for David’s illness. I have the scars to prove it. It has definitely taken a toll on my health. I have fought and won a $9,000.00 claim for services rendered in a California rehab hospital. It took more than two years. I can’t tell how many hours of phone conversations and emails during my lunch break at school were wasted on that nonsense. After many more years, I successfully won a claim of more than $5,000.00 for services rendered by a local hospital. I actually spent several hours in their office tracking down the mistake made by the insurance company.  Why did I have to grovel?

I know I am not alone with insurance woes. I know each and every one of you who read this post have stories of your own. I welcome you to post them in the comment area. (Please do not use specific names to protect yourself.) Below is a letter I recently sent to my insurance company – certified and registered.

Dear Insurance Company:

(Insert your favorite or not so favorite insurance company name.)

I wish you would just pay the claims that you OWE me. You do NOT have to pay me double for claims that you have already paid. Although it was a very nice gesture to write me a check for $3,285.00 – and I realize this may be your way of apologizing to me for my having to battle you to pay the original claims for that amount – I really can’t accept it. I am returning your check of $3,285.00.

I wouldn’t mind it, though, if you were to pay the $50.00 you do owe me, which you are still holding hostage. I am sure if you look at my claims, you will see which claim I am referring to on January 14, 2011. It is the same claim you have consistently paid – both preceding that claim and after that claim. I wonder why you singled out that one. But it would be really nice if you would do the right thing … and pay it.

When we entered into business together more than twenty years ago, we agreed that I would pay you “X” amount of dollars – no small amount each month for your services, which were specified. Each month, without fail, I keep my part of the bargain. You never have to hound me for your monies. We agreed! But, you are not so accommodating. I send in my claims on time. I include all the pertinent information that you require. I even check with you to be sure that the service I need falls under your coverage. But when it comes to paying out my claims, you find some ridiculous excuse to delay my payment – turning me into a beggar and undoubtedly causing health issues, which eventually you will have to pay for. Does this process make sense to you?

On a recent claim, it took a good four months, and my enlisting my university Human Resource agent, to regain the monies that you owed me. That is unconscionable – and it is certainly not a very good business practice.

I have sent in two new claims for this year, and already I have received a letter from you stating: “We have received a claim for services provided to David Figurski by MISCELLANEOUS PROVIDER, (sic) MD. …”

Miscellaneous Provider??? What do you mean? I keep an exact copy of everything I send to you; and I have provided you with the provider name, address, and tax identification number. (It’s no mystery.) It is on the itemized bill that I included with the claim request that I sent to you.  That same itemized bill includes the dates of service, the description for the service, and the charge for each service. I have no clue what you need. Why are you asking me to send it again?

Furthermore, I have sent the same package to you for the past six years. Sometimes you pay with no hassle. Many times I go to battle for it – leaving me totally stressed out. May I remind you again that is not good for my health. Eventually, you pay the claim. I have to wonder – are you earning interest on my money?

I could glean either of two other possibilities from your letter. (1) Either the folks working for you are incompetent or (2) this is a form of intended harassment. (There are too many errors to consider a rare mistake as a possibility.) In either case, it is not acceptable.

So please accept the $3,285.00 check that you sent to me in error; and please, with no further duress to me, process my claims and send to me the monies that you owe me. It’s a simple request. Businesses do it every day. When I go to the grocery store to buy bananas, I pay the shop owner the cost that he is asking … and … he gives me the bananas. Simple!


Donna O’Donnell Figurski
(on behalf of my husband, David)

We need to change the system! This one is broken.

(Clip Art compliments of Bing.)


June 3, 2012 - Posted by | Say It Ain't So! | , , , , , , ,

1 Comment »

  1. Hi Donna,
    Having a little hot chocolate and reading your blog. Love this post and I know how true it is. I don’t know if this is recent or I missed it at some point but I couldn’t help but smile as I’m reading.

    Thank you for remembering my birthday!

    Wishing you and David all good things in 2014.
    Much love,

    Comment by Judy | January 2, 2014 | Reply

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