Today is my last day in the insurance industry. AMA!

What has been your favourite part of the insurance industry?

We occasionally see claims for very traumatic events that require a ton of care. If your injuries are bad enough, and you need a life-flight, you can rack 1 million dollars in charges within a couple of days. And seeing a bill go from that to a few thousand dollars in patient responsibility really shows the importance of insurance. It's what we're all paying into; that moment when someone desperately needs the help and help is there.

Congrats on breaking free of the hive! Someday that'll be me. I don't work in an office, but my job is a real grind.

What do you hate most about the insurance industry?

I guess I'll answer this in two ways.

What I hate about the job: answering the same six questions again and again and again. And people who think the can treat phone reps like shit just because we're paid to be there. Also, people who eat on the phone.

What I hate about the insurance industry: so many people get really angry at their insurance. And granted, sometimes it really just is people getting screwed when they shouldn't. It happens. But more often than not (from what I have seen) people get into bad situations with their insurance when they just fail to do simple things. Did you get a letter in the mail asking you to fill out some information? Did you throw that letter away instead of sending it in? Did you wait a year to call and ask about it? Well don't yell at me, man.

As an insurance agent I'm with you 100% on both counts. We have a very large book of business and do our best to prevent issues from arising, but every now and then something slips through the cracks (or, more frequently, people don't return our calls) and a client just gets screwed with no way to sort them out. I always feel bad but...it's kind of how the system is set up.

It's frustrating, because I definitely want to help people. But this is an area where you only get help if you make an effort to help yourself. You have to be your own advocate.

answering the same six questions again and again and again.

I'll bite. So what are these 6 questions, and what are the answers to them?

1. I lost my card. Can you send me my card? - Yes.

2. I lost this form. Can you send me this form? - Yes.

3. I'm a provider and I want benefits without getting them in the automated system first, even though there's a disclaimer that played literally four seconds ago that told me I have to get them there first. Can't you just tell them to me? - No.

4. I'm an outsourcer who has just the most tenuous grasp of the English language, but I need you to go over minute details on thirty-five claims. Do that for me immediately. - No. No.

5. It's your fault that my claim was denied. Can I tell you all the gross details about what happened to me, details which probably involve poop, so that you can immediately reprocess my claim? No. Just send something in writing.

6. Follow up question. Here's my twenty minute story about what happened, and there's definitely poop involved. Now please reprocess my claim. OH MY GOD WHY DID YOU JUST SAY ALL THOSE THINGS THAT INVOLVED POOP?

Lol at outsourcer one. Gotta love those 😊

Some days it feels I only talk to people with really thick accents who are all named "David".

So those aren't ads from sponsors? Don't they use email for the important stuff? I usually don't open anything and it goes to the recycle...

So you are literally every person that calls in every day?

But seriously, any piece of mail that comes from your insurance company is something you should open and inspect.

I've never called in. I just got my own apartment so I haven't done much yet. I got a job with benefits, so I think I'm good?

It's a good start! Make sure to carefully read over your benefits. They should give you an SPD, or summary plan description, which gives you the basic breakdown of your policy. If you have any questions about what is covered, definitely call in! This is especially true if you're having some kind of procedure done. Call and get all the clarification you need.

Unfortunately (and this can vary from state to state) some documents are required to be mailed. Just, like...open your mail dude. It only takes a minute and you may be saving yourself a lot of future grief.

Learn to adult, people.

What? You mean I shouldn't just put an industrial paper shredder right underneath my mail slot?

Ah ok. I never took it seriously. I will from now on

Just remember: you are your own best advocate. No one will look at for you if you don't.

Have you ever seen interesting evidence of a problem that several doctors and activists talk about regarding an inflated cost of drugs and medical care?

For context: A recent report was done by Consumer Reports which showed that drug prices at CVS was in some cases several times higher than at CostCo. (EDIT: I originally said "hundreds of times", but I actually meant hundreds of percentage points. Reworded to be more accurate and clearer.) There have also been reports about how medical institutions have to bill absurdly high amounts for their care so that they won't lose out on money that various insurance companies might pay. They then just wait for the insurance company to decide how much they will actually pay and adjust the remainder. In some reported cases a million dollar hospital treatment might actually only cost ten thousand dollars if it were paid for without using insurance.

So drugs and hospital claims are two separate issues...kinda.

So with drugs, there is an initial price that is set by the manufacturer of the drug. Then it gets to retail and there is the amount of money that your local pharmacy wants to make on that prescription. They have to pay their employees after all. Drug plans tend to be simpler than the health side and also tend to favor the user a bit more. Many plans feature simple (often low) copays for generics, and sometimes for preferred brand as well. Is there inflation along the way? Of course. There are a lot of people trying to get a piece of the pie there.

Now with hospitals, we're looking at something slightly different. If you are going to an in-network hospital, what that means is that they have a contract that they have signed with the network. The benefit for them is that they are listed as in-network and presumably get more patients. The benefit for the insurance company is that there is now a set price of what will be paid. The benefit to the user is that they get a discount on services for being in network.

If a hospital is complaining because they only make so much from insurance companies...that argument doesn't hold a lot of water for me if they are in-network. They negotiated the contract. They signed off on how much to get paid for services. That's a pretty direct interaction between the hospital and the network they signed up for. There aren't a lot of middle-men there.

What are you going to do now that you're done in insurance?

My degree is in acting, and I will be working full time from home as a voice actor. My studio is all set up and ready to go!

Wow, that's awesome! Good luck. :)

Thanks very much!

Ha! I actually am in the insurance world and I just signed up a voice actor. Good luck to you, he seems to enjoy it very much!

It's not a secure profession, but it's a lot of fun!

Can you post a photo of your setup?

I don't have a full album put together yet, but here's my setup of the acoustic panels! http://imgur.com/a/mSPNn

You can work and be lazy at the same time.
It's like beeing on the moon

I don't even need pants! But I will be wearing pants. Because I know first-hand that working from home can mean not working and just watching netflix. I need more dedication and determination than ever, so pants are definitely going to happen.

Can I actually get Frog Protection?

You know, I bet an insurance agent could arrange that for you. But...I wouldn't.

What are you wearing, "Jake" from "State Farm"?

._. I'll show myself the door

Uhhhh...khakis?

She sounds hideous.

Yeah well...I'm a guy.

Should we switch to single payer?

Personally, I think that the ACA is the start of a good path. We have online markets where it is at least somewhat simple to look over and compare plans. Those who need subsidies receive help in getting insurance, and many many more people are insured.

It's a law that requires some work and tweaking (like every law ever), but I think it's a good start. As someone who needs to get a policy through the exchange in the next couple of weeks, I've found it to be a pretty easy process so far.

You sound like you'd make a great politician.

Is it too late to put my hat in the ring?

Well Reagan was an actor so I'd say no.

PAUL COSCA FOR PRESIDENT 2016!!!

Might want to take your name out of here...

My real name and my username are the same. :-)

I hope we make forward progress on it soon. I agree it's a step in the right direction, but man are certain things frustrating.

My rates are higher, the subsidies varying state by state can be confusing, and certain rules are just outright stupid. For instance, if I buy directly from the insurer, I can change my billing date to whenever I want, but through the marketplace, it's fixed and unchangeable.

To find out that little tidbit took me through 3 different operators. I'm hoping this next year we can work to get more kinks out of this system. I know I'll for sure be buying direct from the insurer to help keep things simple.

I agree! No piece of legislation this big is going to be right on the money right out of the gate. It always requires tweaks and adjustments so that it really works. This thing has so many moving parts that there is just no way to make it work as it should without some common-sense solutions.

Unfortunately, until we get a legislature that actually legislates, we're going to be stuck with the bandaid instead of full cure.

is it though? I mean compared with other 1st world nations the results seem to be pretty shitty

There are a lot of adjustments that need to be made. There's no doubt about that. But is it better than insurance companies having virtually no cap on what they can make in profits from premiums? Definitely. And now, huge numbers of people who have never had insurance in their life now have something. And when it comes to insurance, something really is better than nothing.

oh no doubt is ACA better than no ACA...I just wanted to adress its effectivness compared to other systems (I believe the question was ACA compared to a single payer system) - which seem to be at least A LOT cheaper, I guess its difficult to directly compare results but a theoretical single payer option would cover everybody.

If there's a good alternative that we can move to, where people will get insured and be able to afford it, I'm definitely for it.

Unfortunately, all that we've had since the ACA passed is this Mexican standoff where it's all or nothing. No alternatives presented. No actual plans put forward. I feel like I'm running for president.

See you at the ballot box!

sure, the single payer system looks great (in my opinion) but I know the idea of anything changing in the current situation is wishfull thinking - not even speaking of a complete system change.

Hopefully in the next election cycle we have like...I don't know...five or six people who want to do the job of legislating? Maybe ten?

The biggest problem with it, IMO, is its effect on the lower middle class. I earn just enough that I don't qualify for Medicaid. The result is, I get forced to buy a policy, and the only ones I can afford (even with the subsidy) have a $5,000 deductible. Making $14,000 a year, there's no way I'll ever pay a $5,000 deductible, so the plan is one I can never use.

I actually held an insurance agent's license once, and I seem to recall that selling someone a policy he can never use constitutes open-and-shut fraud. I'd sure like to send Obama himself to prison on one count of fraud for each of the tens of millions of people in my situation.

And he promised he'd only raise taxes on the rich!

Most people will never reach a $5000 deductible.

A cancer patient will reach that in about a week.

Ok, spill it. What if any is a way to get discounted insurance? Say for example, I call my insurance provider today. What do I ask?

While I don't sell insurance, there are definitely some things you can do to lower your premiums. Get healthy, get regular checkups, and do not smoke. You can legally be forced to pay higher premiums if you are a smoker.

I'm young, a nonsmoker who rarely drinks, and I get regular checkups and my premium this year looks to be over 200 a month for a basic bronze level plan. sigh

I hear you. I am about to jump on and grab a plan soon, since my insurance here at work will run out. It's not cheap, even though I don't make much. But even so, I've seen what happens when there's no insurance at all. The worst-case scenario is just awful.

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Haha yes. But I will admit, in all honesty, I have lost some of my empathy. It's one of the reasons I'm leaving. I am a very empathetic person outside of this environment, and I just can't stand losing that.

It's been crushed by the customers.

More by the people who work in the offices of doctors and dentists (ESPECIALLY DENTISTS), but yeah.

I work in a different insurance industry call center so at least I don't have those to deal with!

Seriously, people who work in dentist's offices......

seriously.

In their defense, why does Aetna have plans A-Q or some shit like that?

I must admit, I don't know a thing about Aetna. :/

Apparently no one else does either ;)

I bet customer service over at Aetna do....no, probably not.

Expand on this

Well, we have a few really simple policies here. The big one that applies to providers is that they have to have a written breakdown of a patient's benefits before we can go over them. It helps to confirm accuracy, and it usually takes about 3 minutes to do. They can do it on the website or by fax. This policy is stated in a disclaimer all over the place and plays on every phone call.

So, after all that, fighting me for 10-15 minutes on a thing that only takes 3, and then still having to do that 3 minute thing anyway, gets old. That happens several times a day.

Is there anyway to find out the insurance price of a procedure?

For example, if I get an MRI without insurance, it says it is 1500 bucks. Then there is a so called negotiated insurance price and wondered---how can i get that price if i were to be uninsured?

If you are not insured, there would be no way for you to access the amount that might be paid if you were insured.

But if you are uninsured, often times you will get a bit of a discount from providers, especially if you can pay up-front. And definitely look into payment plans! Most providers will work with you, especially if you are uninsured. It never hurts to ask.

So from the sound of it, are you going on a long road trip or joining an ashram?

I will actually be staying right in my one-bedroom apartment! Monday will be my first day of working from home full-time as a voice actor. But now that you mention an ashram...

Do you know if companies use "Big Data" to calculate premiums for customers ?

While it's not a section of the business I have any serious working knowledge of, my understanding is that there are all kinds of numbers that go into deciding premiums. It's a lot of actuarial work, with people making educated predictions of cost based on trends from previous years. And of course, the more people in the mix, the less everyone has to pay (in theory).

Do you have any experience with settlements? If so, how hard does the company fight to keep the settlement as low as possible? For similar cases, how big a difference is there when a claimant fights more for a higher number?

I do not have experience with settlements, so I definitely wouldn't want to guess at that and give you any misleading information. Sorry about that.

Well that was all the proof I needed you worked in a call center (I have to give answers like this all the time). Glad you're getting out!

Oh yes. I am fluent in English, Legalese, and bullshit.

I'm in need of a new roof (hail damage). Is it best to let the roofing company to make the claim with the adjuster or should I make the claim alone, get the check myself, and then hire the job out privately to keep any extra cash? Better in my pocket than the roofing company. Yes? It will also offset any increase in premiums for the future.Thoughts?

Because I don't work in that kind of insurance, I really don't want to mislead you or give any information that might not be helpful. Perhaps you might find some answers in /r/personalfinance? Sorry about that.

Have you ever watched porn while on work?

Are you from HR??

You can't prove anything!

Hahaha Who makes you angry the most, your boss or the customers?

My boss is actually great. She's the best one around. People who call in and have no idea what they want, need, or are talking about...that is the frustrating part.

What are your opinions on Whole Life as opposed to term? I'm a healthy mid 20's guy. I won't qualify for whole life insurance in a few years so should I go for it now (25yrs/500k compounding/qualified as lowest rate possible) considering it as a safe investment and knowing that in 25 years I'll have 800k+ of coverage?

I don't deal in life insurance, but I went ahead and did some research. It seems that, if you're looking at a long-term investment and can afford the payments, whole life is the way to go. I read an article which mentioned that you can add riders to whole life, like if you get terminally ill you can access a lot of the money before your death to help cover costs. That seems like a smart investment to me. But definitely get the opinion of someone who deals specifically in life insurance, as they might have a more detailed perspective on that.

You should ask this on r/personalfinance. Generally, the only people who thing Whole Life is better than Term for 99% of the people are insurance agents who make insane commissions on it.

Edit: Specifically, read this Wiki on the topic. And get some further info from people who do not have a vested interest in pushing one product or another.

Gathering multiple opinions about a big financial decision is always a good thing!

Where there any times where you felt you could of helped someone that deserved it but couldn't?

Definitely. But every time, and I mean every time that has occurred, it was because information that we needed wasn't sent back to us. I've seen people have to eat tens of thousands of dollars in bills because they didn't take the time to fill out a two-page form that was sent and never called to follow-up with it.

A good friend of mine has Metastatic Stage IV Breast Cancer, she was diagnosed with a brain metastasis and her Oncologist said they needed to move fast and hit it with radiation to stop it from, well, killing her.

The insurance company said it may take up to 4 weeks to approve the procedure. This is not moving fast.

Can you explain to me why I should believe anything an insurance company claims about them caring, being good or being Human in the first place?

And this is not my first experience with insurance trying to wiggle out of paying for a procedure. I was forced into bankruptcy and had my credit destroyed after an insurance company pre-approved a procedure, then denied it after it was done, and I was sued.

I appealed with them and talked to attorneys, all who told me I had no recourse because I signed papers when I had the procedures done and I signed papers with my insurance company.

Did you see any of this?

Obviously, I can't speak to what you went through and what your friend is going through. I'm very sorry to hear about both.

Here, authorizations take about a week. The only time that timeline gets extended is if it is a complex procedure and an independent medical review is required. If that's the case, it is sent off to a company that hires independent doctors in the same field to review those records and make a determination about whether or not the procedure is medically necessary. In those cases, we defer completely to that decision.

I can't speak to every company. But here, it's no real skin off our back to pay a claim. The examiners who process those don't have any incentive to not pay a claim. So as long as it meets the guidelines for medical necessity, it goes through no problem.

That is good to hear, maybe I will not blindly hate all insurance from the get go!

It's definitely best to keep an open mind. There are rats in every industry, but most of the people you'll encounter through insurance really don't have a personal stake in denying a claim.

which carrier?

I work for a regional TPA that is owned by Cigna.

someone I know claimed their homeowners insurance threatened to drop them if they did not completely re-stucco the outside of their house. Yeah there are a few cracks, but in no way is it falling apart or in need of replacement. Does this sound like something an insurance company would do, or is this person probably lying to me?

Unfortunately, that is not a kind of insurance that I deal in. I could make guesses...but I'd have no way of backing them up. Maybe a home-owner's insurance adjuster will drop by with some helpful info?

What do you think about socializing health care?

If you mean the ACA, I can reiterate a point I made in another comment. I think that the insurance industry has been in desperate need of regulation for a very long time. There was not a whole lot stopping carriers from milking users for all they could.

The ACA is not perfect. No law is, especially right out of the gate. It needs tweaking and adjusting (which every law goes through). But it's a good start. We have more people insured now than ever. More people who don't have to be afraid of getting hurt or sick. When I was without insurance, I probably wouldn't have even gone to the hospital for a minor head injury or a minor bone break. So, I think we're on the right track. Now we have to continue massaging it into place.

Is there good money to be made in the insurance industry? Were you doing commercial? Have you gotten a lot more business recently due to the El Niño storm coming?

Thanks

That's a different kind of insurance. You're thinking a bit more of people who sell insurance. And yes, for those who are good salespeople, you can make a killing in insurance sales.

I however, am absolutely terrible at sales.

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With a head for math, being a claims examiner could be a good position! It's not an advanced position, but as an examiner, you'd be the one reviewing claims and running them through the system for processing. It's a very detail-oriented job and doesn't require anything more than a bachelors.

Does the company you work for rhyme with "my toe"? Also, is/was your job commission based?

I work for a smaller, regional company, though we are owned by one of the big ones and have plans across the country.

My job has been in customer service. So a low, hourly wage.