Blue Cross/Blue Screws of several incarnations lived up to their names. One friend had a newborn spend 10 days in NICU because of asthma. St. Louis Blue Screw didn’t pay a penny because “We don’t pay for well child care.” That guy went bankrupt. My husband tore some cartilage at age 30; it was a “pre-existing condition,” according to them. After all, he had had that knee for 30 years! It wasn’t until the surgeon, who happened to be the guy who operated on the St. Louis Cardinals and was the president of the AMA chapter informed them that no physician in St. Louis would accept their insurance if they didn’t pay the claim that they finally paid it. Another lady dropped a file cabinet drawer on her foot and broke it in July, half-way through the premium year. The same Blue Screw denied the claim as a “pre-existing condition.” Her husband had coverage with another company and paid the claim. They then informed Blue Screw that “We have as many lawyers as you do,” and they paid up.

We sued one insurance company and got raped in court because they insured every court official in town. Transcripts are available. The details are really scary.

You have been very, very, very lucky. Your people had cancer, which insurance companies actually believe in. Try getting chronic fatigue syndrome, or lyme disease, or something they don’t believe in. Try having MS with very expensive treatments that are “experimental.” Try having the plain language of the contract state that they will cover something and have them deny it just because they can, because they know you can’t afford to sue them.

I hope your luck holds. Don’t count on it.

Oh — not one of these claims were fraudulent. I know some people file such claims. I also know from my experience, and that of many more friends both personal and internet, that far more denials are fraudulent. They do it because they can.

Over the course of 38 years of having my individual health insurance plan, I’ve had three years of high claims, but never any denials. I also saw my parents go through years of extraordinarily high claims with very few minor denials, and a sibling go through years of cancer treatment (two different major types of cancer) with no denials. This may be because we purchased our policies from reputable insurers, bought the kind of policies we needed, and knew what they covered and didn’t cover.

I’ve also been with the same car insurance company since 1977, and had two major and several smaller claims, all handled expeditiously and to my satisfaction. A few years back, I had a major claim against a rental property casualty insurer when a rental house was struck by lightning and suffered a major fire, and several smaller claims against homeowner policies, again all handled beautifully.

In other words, in 40 years of adult life, I’ve had lots of opportunities to interact with insurance companies, and zero occasions to regret it. In fact, since I’m aware through my professional work of how often insurance claims are fraudulent or unfounded, I’m surprised at how very well I’ve been treated as a customer.

You’ve obviously had some bad experiences, but you are stretching them to cover too much ground.

AnnJo, you are obviously basically healthy. Once you have claims exceeding a certain amount, the health insurance companies start denying almost everything. There is an absolutely irreconcilable conflict of interest between profits and paying claims, which is why no health insurer (or any other kind) should be for-profit. And the “non-profit” insurers have for-profit arms into which they funnel their excess income based on fraudulent denials.

Insurance companies ARE in the business of screwing over their suckers, er, customers. And they have bought our lawmakers and the state insurance commissioners, who almost always move on to a cushy job with the companies they are supposed to be overseeing.

If you ever get really sick, you’ll be experiencing the very same thing.

That being said, I doubt if claims denials are all that different between profit and non-profit plans. I’m just saying you’ll FEEL better about it if you’re profit-phobic. Placebo effect.

The point being, insisting about something can increase your chances of getting your claim covered, even if you are told no at first.