You win some you lose some

Personal, professional, and just going shopping--we want life to be fair. So, let's be fair and why not share your wisdom? Maybe we'll make the world a better place. When have you succeeded in getting what you want through fairness and perseverance? Write your story and give details, where you went, what you asked for, how long it took to resolve. We can't vouch for your honesty and we're not interested in how you scammed your way to success (if that's the case), but whether you advocated for someone else or yourself, let us know.

We can also learn from failure so let us know what doesn't work.

Benefits season: Here it is again. Choose your health plan. We see it in the news, politics and in our own wallets. After thirty years of ongoing experience in this field here is the overall answer: If you've never had a serious medical event or a chronic illness then you aren't worried about health insurance. Why? Simple, you've never needed it.

Basics: The hardest thing to accept about health insurers, the people we pay for health insurance is that we have an adversarial relationship with them. We pay them in case we need them, they make money when we don't need them.

WHAT WORKED: Health insurance policy that includes (at extra cost) a vision services plan. This covers an annual eye exam and some dollar amount worth of glasses or contacts. After calling an eye doctor for an appointment and confirming participation with VSP, eye exam given. Suddenly there is a $16 bill for the eye exam, why? RESULT: $16 refunded

Turns out the eye care provider decided to institute an office policy of requiring retinal imaging for all patients. Though retinal imaging has value (especially re diabetics, those with high blood pressure, etc.) it is NOT covered in the insured eye exam.

CLAIM: Fraud-deliberate misrepresentation of a material fact relied upon by consumer to his detriment.

Steps taken: Complaint to doctor's office (no satisfaction), franchise company (automated response), VSP (slow response), nearby university health services that required the exam for students and Better Business Bureau for the region.

Though we're not sure which one worked, the doctor himself called and tried to argue that there was no fraud. No dice with us because BUT FOR THE CLAIM THAT THE DOCTOR WAS A VSP PROVIDER WE WOULD NOT HAVE USED HIS OFFICE. By trying to raise the dollars he got (VSP dollars plus mandatory $16 retinal imaging fee), the consumer was not in fact getting the benefit of VSP.

TIme: This took about two hours of letter writing plus phone calls to doctor's office and time on phone with doctor when he called consumer.

WHAT DOESN"T WORK: Psychological testing reimbursement amount $400.00. Health insurance coverage by United Behavioral Health $0. This testing was recommended, consumer called company and was told that it would be reimbursable. Reimbursable ONLY IF THE CONFIDENTIAL RESULTS OF SUCH TESTING ARE PROVIDED TO THE INSURER. We checked this one out with the appropriate HIPPA office. The twist: Insurance companies CAN impinge on the confidentiality of doctor/ patient relationship by requiring the full report of diagnostic testing (instead of just a list of what tests were administered) before they reimburse. NOTE: We chose to preserve confidentiality and ate the cost. We name the company here because of course we have the documentation to back up the facts stated.