Complaint Review: United American Insurance - Colorado Springs Colorado

Addressing the concerns of those who never read their policy!! Reply: at least you as a loyal employee responded, I don't think from your response that you as a manager/agent or any of the other manager agents, have ever confirmed that you or the others use the insurance you sell, even the premium coverage as the health insurance protection for you or your family relies upon. Note the reply from the Ex-employee the higher ups used the BC-BS for their coverage. I would like to address the comments made by this user in a cohesive and coherent form: Reply: yes you gave responses to each point, but luckily I too once took debate and am quite familiar with a point-counterpoint response. The average customer does not think the word insurance means some token payment "for the effort" so to speak. The person buying insurance believes they have real protection against the costs, and trusts that the upper cap on even your best policy would prevent their financial ruination. UA is at least insurance, but extremely poor, and in fact will cost you more money than it could pay in benefits. UA (called that primarily by agents of which I assume you might a disgruntled one) IS insurance. It pays some benefit from the first dollar of expense. It is not and has never purported to be a major medical policy. Reply: I have never worked for UA, and yes UA SHOULD pay a token amount, on the policy I was sold, but even your top-of the line policy has caps that are low, and your agents dont seem to know how low the cap is compared to ever increasing charges that a covered event will be charged, (See below for some numbers) They offer to pay only for in patient hospital stays some token amount of 1-200 dollars a day, nothing else for an overnight stay. There are so many policies available under the rubric of the United American Insurance Company, that is would be libelous to say that ALL of the policies pay only for in patient hospital stays. If that is the chosen policy, of course it will only pay for $100 to $200 per day. However, the premier product and, by far, the most popular product pays 80% up to $4,000 per day for daily room and board at a hospital. Reply: You left out the low upper cap and the monthly cost of that premier product, and ignore the fact that Room and board charges will not be even 60% of an average bill for a hospital stay. Ok not all, but show an example with real data, of how it didnt cost more, or respond with a PMPM for medical benefits? Most sales literature likes to hit the topics and word the non-insider person, as in the average customer, likes and create a feeling of benefit, careful of using libelous as that could be considered to slanderous!As a licensed Life agent, can you guess within even 10% of how much the hospital bill is for therapeutics and diagnostic procedures? Or what the averaged total billed cost of a hospital stay per day? I understand that an agent should know the definition of what "is" is, but your clients dont. So under the rubric of common understanding before a jury of their peers, your rhetoric would inexorably induce somnambulance or other altered state of less than full understanding Un-discounted charges at hospitals average 15-20 times that amount for a stay, and worse a patient would get a better rate for 'no-insurance' and working to pay off the stay, then having the provider 'bill' the insurance. Yes, standard, retail charges at a hospital can be high. But what you are really getting with a PPO network and an insurance company that uses them is the negotiated rate and then the insurance company pays towards that negotiated rate. For example, let's say that the daily room and board charge is retail at $6,500 per day. With a PPO negotiation it may come as low as $4,000 per day of which a patient would pay 80%. Reply: Can be High? They are high! Lets use your $6,500 a day number and the customer could be responsible $800 plus doctors, transport, therapeutic, diagnostic, etc. (More below) Example standard cost of an overnight stay in an observation unit gross charge $2,980 If you used UA, and IF UA paid the bill for such a stay they would send the hospital $100, and the patient would be on the hook $2,380 out of pocket; after the provider gave a discount to an accepted local fee schedule, amounts are estimates from a 20 year professional of Health care finance and 9 year financial professional with major health insurance companies. (for this benefit you pay them a 100 a month btw, and surgery coverage hah, less than 1 in 100 patients has an inpatient surgical procedure for any hospital stay) So, let's use your example: a gross hospital charge of $2,980. With the discount, the charge would be reduced to around $2,586 and UA would pay $100. This plan reflects the lowest priced policy available. The agent would present this plan when the client complained that the price of everything else was too expensive and he or she could not afford a better plan. What is accomplished in this scenario is that the client has access at least to the highest quality of healthcare available even if they have some potential out of pocket at the termination of the medical event. Reply: Your response is that UA would pay the hospital the equivalent of one month of premium for the lowest priced policy? So then the lowest policy is worthless as the customer owes more to the hospital with UA, then without, and is out the premium. The client would have access to the highest quality healthcare because they have an UA card? (Yeah right, lets see you pull that off in Palm Desert if closest hospital is where Sinatra was taken ;). And their potential out of pocket is about a probable certainty as one can get. So what would the cost of your premier coverage plan be and how much would it reimburse? Go ahead dont be afraid use a real charge from a real patient bill in California where you work apparently. The 'no insurance' standard write off by the hospital with less negotiation would be out of pocket $1,200. The fact that hospitals have to take these write offs at all, due to indigent people or those who simply skip out on the bill, is the reason the insurance submission rates are so high. Reply: I will remember not to contact you or your agency for relief, help for the homeless, or assistance for the poor. However cost shifting through charge increase from those who cant pay to those that do is real and will continue, in fact UA customers had better have pretty substantial assets to pay those non covered charges, co-pays. Really have you, Ex-employee ever had a covered visit? Using even the premium plan? What about the costs of outpatient care, therapies, doctor visits, medication charges. People need insurance to cover most if not all of their medical charges, not pieces. Most of us poor folks cant afford to spend more for limited insurance then we do on mortgages or rent each month. Why? do things like this happen, if you look around and ask the right people in patient finance/admissions/ medical clinics billing organizations( which is a long frustrating ordeal of being passed off from one to another) you will find that frequently providers charge more for the hassle of going through insurance than their cash price. Not all providers have a cash/no insurance price. Are you aware that it is illegal in these here United States to charge one party one price and another a completely different price? The price is the same for the insurance companies and what you get by paying your one hundred dollars each month is the power of the negotiated PPO price that the insurance company has been able to acquire due to the volume of its patients it is submitting to the provider. Reply: Charges arent different but the discounts sure are, some pigs are more equal than other pigs (orwell). And your counterpoint ignores prior point that the one hundred dollars a month is paying for the privilege of paying more out of pocket for the procedure (observation visit above) than with the insurance. ( no UA $1,200 out of pocket, with UA $2,486 and the monthly premium, using your numbers above) In short, the math of how insurance companies work is you pay a monthly amount, they pay the agent, the office, the boss, the other printing and administrative charges (per member per month, its the insurance bizz talk) and then the insurance company invests in a pool to fund your charges, and you guessed it not much, I would bet the 'risk' financed by my monthly fee is probably about a dollar a month given the age of my wife and I. Of course UA might tell you its major medical coverage but the benefits they pay, were exceed by providers in the 1960's! No UA agent can ever tell you that what you are enrolling in is major medical and in point of fact, one of the documents you sign upon enrollment is acknowledgment that this policy as low priced as it was clearly not major medical. Reply: NO Agent should, ours did not to both their credits, but it is still the lowest benefit for the cost I have ever seen presented, or verbally promised. The premium plan, we had an over the phone quote was better coverage and almost 5X as much, and still left gaping coverage holes. Also UA high ratings the agents and literature talk so much about are primarily on the Medigap policy. But of course that information is not readily made available, and in fact our agent in the follow up call, did not know about. The national average for ICU Intensive care unit charges is a $100 and hour, on top of a avg. room charge of $350 per day, and then there are staffing, labs, medications, Oh and remember you still need to pay the doctor! No comment, but I challenge your figures in the extreme. The average room charge in California starts at least at $1,000. Reply: proves my point even more, you present California as higher in price but dont talks anything about ICU surcharges, monitoring etc. So in California a premium cover UA client would pay out of pocket $200 a day, if they had no diagnostics, no therapeutics, and not medications, and no doctors visit. I think you have just given proof to my original point. I had two non surgical, medication and monitoring visits in the last 40 years of my life, the total bill for the 2 day stay was 25K the full insurance I had the paid the hospital $2,768. Two years later, new employer new plan, a three day stay was charged out of $35,986 after discounts the regular health insurer paid the hospital in full $3,121 including physician fees! And I'd be willing to bet that both plans were major medical plans and not specified or limited benefit plans such UA has pioneered and made successful throughout the United States. Reply: Yes they were HMOs, however they use the same advertising as UA does as Health insurance. These plans are currently advertised, on the same site where UA got my name from, as being comparable in price to the premium UA plan, or course if issued preferred for the PPO major med coverage. Both still leave 20% to the patient as co-pay, co-insurance, or out of pocket costs. My agent and assistant are nice people, they didn't mislead us but, they obviously forgot when I told them I knew a few things about the system and knew a little about the insurance biz! For any manager or higher up in UA, tell me you used the same insurance policy you peddle for you own coverage! and then back it up with some numbers. As a manager at UA, I know of several managers and agents who have and use our policies with great success. You have a tiny, very low priced policy and, while I am sure it was all you afford, you cannot judge all of UA s policies by your inability to secure a better plan. ExEmployee Submitted: 10/9/2007 4:24:52 PM Modified: 10/9/2007 5:52:57 PM Reply: At least you replied, Thank you and that shows a belief that you believe UA is helping people. But saying you know several out of thousands of employees, and by lack of affirmation exclude yourself using a UA policy for health coverage, says a lot to me Platitudes though do not help people ExEmployee Lexy Sanford, Florida U.S.A. Managers with UA don't even have UA as their Health Insurance For the Record, Branch Managers for UA and up get their Health insurance paid for its not UA, when I worked there it was Blue Cross Blue Shield, Go figure.

For the Record, Branch Managers for UA and up get their Health insurance paid for its not UA, when I worked there it was Blue Cross Blue Shield, Go figure.

I would like to address the comments made by this user in a cohesive and coherent form: UA is at least insurance, but extremely poor, and in fact will cost you more money than it could pay in benefits. UA (called that primarily by agents of which I assume you might a disgruntled one) IS insurance. It pays some benefit from the first dollar of expense. It is not and has never purported to be a major medical policy. They offer to pay only for In patient hospital stays some token amount of 1-200 dollars a day, nothing else for an overnight stay. There are so many policies available under the rubric of the United American Insurance Company, that is would be libelous to say that ALL of the policies pay only for in patient hospital stays. If that is the chosen policy, of course it will only pay for $100 to $200 per day. However, the premier product and, by far, the most popular product pays 80% up to $4,000 per day for daily room and board at a hospital. Un-discounted charges at hospitals average 15-20 times that amount for a stay, and worse a patient would get a better rate for 'no-insurance' and working to pay off the stay, then having the provider 'bill' the insurance. Yes, standard, retail charges at a hospital can be high. But what you are really getting with a PPO network and an insurance company that uses them is the negotiated rate and then the insurance company pays towards that negotiated rate. For example, let's say that the daily room and board charge is retail at $6,500 per day. With a PPO negotiation it may come as low as $4,000 per day of which a patient would pay 80%. Example standard cost of an overnight stay in an observation unit gross charge $2,980 If you used UA, and IF UA paid the bill for such a stay they would send the hospital $100, and the patient would be on the hook $2,380 out of pocket; after the provider gave a discount to an accepted local fee schedule, amounts are estimates from a 20 year professional of Health care finance and 9 year financial professional with major health insurance companies. (for this benefit you pay them a 100 a month btw, and surgery coverage hah, less than 1 in 100 patients has an inpatient surgical procedure for any hospital stay) So, let's use your example: a gross hospital charge of $2,980. With the discount, the charge would be reduced to around $2,586 and UA would pay $100. This plan reflects the lowest priced policy available. The agent would present this plan when the client complained that the price of everything else was too expensive and he or she could not afford a better plan. What is accomplished in this scenario is that the client has access at least to the highest quality of healthcare available even if they have some potential out of pocket at the termination of the medical event. The 'no insurance' standard write off by the hospital with less negotiation would be out of pocket $1,200. The fact that hospitals have to take these write offs at all, due to indigent people or those who simply skip out on the bill, is the reason the insurance submission rates are so high. Why? do things like this happen, if you look around and ask the right people in patient finance/admissions/ medical clinics billing organizations( which is a long frustrating ordeal of being passed off from one to another) you will find that frequently providers charge more for the hassle of going through insurance than their cash price. Not all providers have a cash/no insurance price. Are you aware that it is illegal in these here United States to charge one party one price and another a completely different price? The price is the same for the insurance companies and what you get by paying your one hundred dollars each month is the power of the negotiated PPO price that the insurance company has been able to acquire due to the volume of its patients it is submitting to the provider. In short, the math of how insurance companies work is you pay a monthly amount, they pay the agent, the office, the boss, the other printing and adminstrative charges (per member per month, its the insurance bizz talk) and then the insurance company invest in a pool to fund your charges, and you guessed it I would bet the 'risk' financed by my monthly fee is probably about a dollar a month given the age of my wife and I. Of course UA might tell you its major medical coverage but the benefits they pay , were exceed by providers in the 1960's! No UA agent can ever tell you that what you are enrolling in is major medical and in point of fact, one of the documents you sign upon enrollment is acknowledgment that this policy as low priced as it was was clearly not major medical. The national average for ICU Intensive care unit charges is a $100 and hour, on top of a avg room charge of $350 per day, and then there are staffing, labs, medications, Oh and remember you still need to pay the doctor! No comment, but I challenge your figures in the extreme. The average room charge in California starts at least at $1,000. I had two non surgical, medication and monitoring visits in the last 40 years of my life, the total bill for the 2 day stay was 25K the full insurance I had the paid the hospital $2,768. Two years later, new employer new plan, a three day stay was charged out of $35,986 after discounts the regular health insurer paid the hospital in full $3,121 including physician fees! And I'd be willing to bet that both plans were major medical plans and not specified or limited benefit plans such UA has pioneered and made successful throughout the United States. My agent and assistant are nice people, they didn't mislead us but, they obviously forgot when I told them I knew a few things about the system and knew a little about the insurance biz! For any manager or higher up in UA, tell me you used the same insurance policy you peddle for you own coverage! and then back it up with some numbers. As a manager at UA, I know of several managers and agents who have and use our policies with great success. You have a tiny, very low priced policy and, while I am sure it was all you afford, you cannot judge all of UA s policies by your inability to secure a better plan.