Recommend a good health insurance policy

[88sins]

pete, how i do my business aint your business
But i will say there is nothing fraudulent or illegal about any insurance claim or transaction i may make. No inflated invoices, or claims to multiple companies with multiple receipts from one procedure. All my dealings are always legal & legit.
I just learned early on how to manipulate the systems.

[88sins]

And yes it have room and loopholes to manipulate wrt insurance. Some have less and some have more. But they all have.

[10-01]

pete, how i do my business aint your business
But i will say there is nothing fraudulent or illegal about any insurance claim or transaction i may make. No inflated invoices, or claims to multiple companies with multiple receipts from one procedure. All my dealings are always legal & legit.
I just learned early on how to manipulate the systems.

kindly share with us so we can reap the benefits also plz

[Premchand1976]

It seems this guy knows me personally but is hidden behind a user name. My name is public for all to see. It's OK. At the end if the day regardless if Guardian is inferior or not he still uses them for profits. Which would mean they pay their claims. Which is the real question everyone asks about an insurance company before joining them.

Our plan has flaws, every plan has flaws but personally i have been to doctors, dentist, optometrist, nursing home and pharmacies since joining the plan years aback and to date I have never had a scenario to pay my bill up front, be denied entry to an institution and have a claim pending. Yes, I may have gotten a surprise when we got back the Obstetrician fee ( 5k reimbursed from 12k payment ) but all in all I am happy and comfortable.

Note too, the fees are actually provided by MPATT, and not set by guardian themselves despite what you may know, believe or have heard ????

I'm only an agent yes, but I also deal one on one with the VP, and managers at the highest level since we have an open door policy, and get results.

Maybe it's a case of the fox and sour grapes ???

This is not to be little anyone but simply to enlighten us all about each policy, companies and their shortfalls. Maybe the personal attacks can stop now 88sins?????

Continue to make your profits, but don't bite the hand that feeds you.

[Strugglerzinc]

How does one make a profit from an insurance claim?

[10-01]

How does one make a profit from an insurance claim?

[Premchand1976]

Simple. One must have estimates, higher than the actual costing, for medical claims you and the doctor / institution must be " good " for him to " doctor " the charged figures.

For motor claims, estimates from big time repairers and then you get a " small garage " to do the job for less and around same quality as big garages.

Other than that, you hadda be working in the claims department and doing your " own thing ".

Whatever the guy does, unethical as it may seem, he's comfortable with it. At least he is one person that can safely say " insurance is not ah ripoff ".....lol

[88sins]

So Prem me stating my opinion about GL is a personal attack on you? Skin too thin son. Reread my posts & you might notice that a few key details. Such as that I did recommend GL, I just put them second to Sagicor. And i stand by it.

It aint personal son. So dont tote no feelies ok. Totin feelies dont build strength or muscles.

[SmokeyGTi]

I used to be in a Company group health plan with sagicor. They were great ...until it seems they bit off a little more than they could chew, service degrated somewhat because of the number of clients that signed up with them.

My experience was that cheque turnaround time was great. however they gave REAL problems to add people to the plan - it took forever to "underwrite" them.

We switched to Beacon and haven't had a problem since.

I think Sagicor is still a good option for personal health insurance though. Plus if you get at least 5 persons to go in with you, you can form a group and have access to better rates and coverage.

[Slartibartfast]

Sagicor was decent until they increased their prices by 50% last year. To top it off, I was quoted the old prices to pay but when I went in to pay they charged the new price and just dropped dental and vision without telling me because it was costing about the same. Stupid me wasn't aware of the new prices at the time so I was only informed that I had no dental/vision when I tried to make a claim.

Other than that, all I can say is that they are very efficient and taking my money. I have no other experience with them but as a matter of principle I'll most likely just drop them at the end of the year. Considering GL.

[88sins]

I used to be in a Company group health plan with sagicor. They were great ...until it seems they bit off a little more than they could chew, service degrated somewhat because of the number of clients that signed up with them.

My experience was that cheque turnaround time was great. however they gave REAL problems to add people to the plan - it took forever to "underwrite" them.

We switched to Beacon and haven't had a problem since.

I think Sagicor is still a good option for personal health insurance though. Plus if you get at least 5 persons to go in with you, you can form a group and have access to better rates and coverage.

yeah sometimes with group policies wrt adding employees it does take a while, especially for large companies. For individual insurance they real good.

Sagicor was decent until they increased their prices by 50% last year. To top it off, I was quoted the old prices to pay but when I went in to pay they charged the new price and just dropped dental and vision without telling me because it was costing about the same. Stupid me wasn't aware of the new prices at the time so I was only informed that I had no dental/vision when I tried to make a claim.

Other than that, all I can say is that they are very efficient and taking my money. I have no other experience with them but as a matter of principle I'll most likely just drop them at the end of the year. Considering GL.

something seems amiss here. If they quoted you the old premium inclusive of vision & dental, and when you went in to pay they charged you at the new rate and you paid the new rate which included vision and dental, they can't just drop your vision & dental coverage without you knowing. Because you already paid for it and it shows you have vision & dental coverage in your policy.

[Slartibartfast]

Sorry, I worded it badly. Say the old price with dental and vision was $4650 or something, I got a note in the mail in November saying that I needed to pay that before the end of the December. However, unbeknownst to me, the premium increased drastically at the beginning of December so the price of basic coverage without dental or vision was say about $4850.

Now I walk in, present the letter and informed the clerk that I would like to pay that amount which was more than my previous year because I am adding dental and vision (didn't have it previously). I made sure to specify that I wanted the dental and vision. He told me things were in order and I got an invoice or whatever for an amount very close to what I was quoted so I thought nothing of it (assumed extra was probably VAT or service charge or whatever, I was in there long and was in a bit of a rush by the time I had to leave).

Flash forward about 7 or 8 months. I tried to make a claim under the dental/vision plan and got a letter saying I wasn't covered.

So apparently I never paid for dental and vision. Only thought I had because I specified I wanted it but the clerk didn't inform me that the new plan w/o D&V was about the same price as the old plan with it. Right now I may or may not stick with them. Wanted to check guardian but from reading this thread they seem like a hassle.

[Dreamygirl]

Ok .i went to maritime.i will be going with ADmed after weighing my options

[AbstractPoetic]

Hello.Can anyone recommend an insurance company with a reasonable health plan .IM looking at medical,dental and vision.

For me, a "best health insurance" will allow me or my family to travel abroad (particularly to the UK or United States) for any major or invasive surgery. I found that Guardian's Group medical insurance far exceeded that of other competitors with respect to what's covered, separate from the vast number of UK and US healthcare providers that are a part of Guardian's network.

[jose123]

Old thread, but I'm responding.

I had to get a vaccine.
According to the sales pitch, Guardian's site and the included capture from the schedule of coverage I am covered.
http://www.myguardiangroup.com/trinidad/forms/Provisor.pdf


The "preferred" provider said they do not take the insurer's card nor fill out forms for immunisations.
After a week of waiting and a second e-mail I get this from the agent:
"Hello Mr. Mohammed,
Apologies for my delayed response; have been in and out of office this week.
Vaccine is claimable under particular plans that has it included under their Preventative Care benefit for adults.
Upon review, you plan however, does not have this benefit for adults. This being so, you will not be able to claim for this vaccine.
Regards, "

This is my 1st claim after paying this premium for 3 years. I wonder what I "will not be able to claim for" that's also in the schedule . . .

[Premchand1976]

Is this a company plan or individual ? Did you already submit medicals for the year ? Vaccinations are covered and there is no deductible applicable on this benefit . Your schedule of benefits confirms vaccinations are covered but maybe there is some other reason they said it isn't ?

[Premchand1976]

Also, change that agent today. If it's there on the document and that person can say it's not covered, they don't know what they selling, maybe they don't even have one for themselves?

[Premchand1976]

Also, the provider CANNOT refuse your card UNLESS, they have been removed from our panel ? They supposed to fill the provider form or your claim.form if they not on our panel......if they refuse, report them to guardian and find another provider.

[jose123]

Individual. I am not required to submit medicals this year.
The provider in question is the Medical Associates Hospital in St. Joseph. It was at their A&E and not one of their outside doctor clinics which should still be covered by 80%. MA is one of the preferred providers. I can only imagine in an emergency I would be left to die on the hill because they may say my insurance provider does not cover what the schedule says!
I have contacted some higher ups at Guardian. If a satisfactory response is not provided I'm taking this to the Financial Ombudsman even if it means they will not insure me anymore.

[88sins]

Also, the provider CANNOT refuse your card UNLESS, they have been removed from our panel ? They supposed to fill the provider form or your claim.form if they not on our panel......if they refuse, report them to guardian and find another provider.

yuh real fass & outta timing with this post. exactly what the hell you feel guardian is exactly?
Short story shorter, GUARDIAN CANNOT DICTATE WHAT GOES ON WITHIN A COMPANY IT DOES NOT OWN OR CONTROL, no matter how they may disapprove. You & your clients can report the provider to guardian all you want, guardian cannot & wil not do diddly squat other than adjust their provider network brochure & send out emails to reflect that that particular provider no longer does business with guardian as a provider. Neither guardian, nor it's agents, nor legal dept, nor clients can do squat else.

Now, instead of posting assness on tuner to boost yuh feels about guardian because they pay yuh salary, answer the following question for all to see.


If a company agrees to be a provider on guardians preferred provider network, and everything going hunky dory & all is well, provider having ALL their claims settled IN FULL & in a PROMPT & TIMELY MANNER, why then would the provider refuse to accept a valid guardian insurance card & insist your client pay up front for service?
Provided the agreement between the provider & guardian hasn't changed or been breached, once the provider is getting their all their claims paid in full & they getting their money in a timely manner, why refuse good business without informing guardian & put guardian clients on the spot? Once things happening the way allyuh like to say it does happen, why fix something that ain't broke ?

allyuh insurance agent's like to put rainbow sprinkles on dogshit & tell ppl is chocolate ice cream. first & last lick is yours, & all those between while yuh at it

[jose123]

Also, the provider CANNOT refuse your card UNLESS, they have been removed from our panel ? They supposed to fill the provider form or your claim.form if they not on our panel......if they refuse, report them to guardian and find another provider.

yuh real fass & outta timing with this post. exactly what the hell you feel guardian is exactly?
Short story shorter, GUARDIAN CANNOT DICTATE WHAT GOES ON WITHIN A COMPANY IT DOES NOT OWN OR CONTROL, no matter how they may disapprove. You & your clients can report the provider to guardian all you want, guardian cannot & wil not do diddly squat other than adjust their provider network brochure & send out emails to reflect that that particular provider no longer does business with guardian as a provider. Neither guardian, nor it's agents, nor legal dept, nor clients can do squat else.

Now, instead of posting assness on tuner to boost yuh feels about guardian because they pay yuh salary, answer the following question for all to see.


If a company agrees to be a provider on guardians preferred provider network, and everything going hunky dory & all is well, provider having ALL their claims settled IN FULL & in a PROMPT & TIMELY MANNER, why then would the provider refuse to accept a valid guardian insurance card & insist your client pay up front for service?
Provided the agreement between the provider & guardian hasn't changed or been breached, once the provider is getting their all their claims paid in full & they getting their money in a timely manner, why refuse good business without informing guardian & put guardian clients on the spot? Once things happening the way allyuh like to say it does happen, why fix something that ain't broke ?

allyuh insurance agent's like to put rainbow sprinkles on dogshit & tell ppl is chocolate ice cream. first & last lick is yours, & all those between while yuh at it

I wasn't going to be so raw, but is basically my thoughts. If MA is no longer in their network Guardian will loose me as a client.

Also, even if they are not a provider they should not refuse to stamp claim forms.

These things can only fly in lovely TnT...

[88sins]

bossman, only thing more blunt than me is blunt force trauma
I have a nasty habit of calling it as it is, & as I see it, & who eh like it hadda learn to live with it

[88sins]

& if guardian resident tuner agent eh like MY statements, I will retract them.
as soon as guardian settle all my o/s claims they never paid & never gave a reason for not paying in writing or otherwise
, furthermore, make that eveybody. But they eh go do that, cuz they would go bankrupt if they did
If ANY guardian agent eh like MY statements, they could bite big stone & sip lanate as far as I concerned

[Premchand1976]

You ever went to the doctor and ask the cost and when you declare you have insurance, the cost change upwardly ? Based on what I saw on the schedule of benefits, you are insured for vaccinations .......you were supposed to get a statement of the claim particulars with all info listed and a code at the end of the breakdown ( 3 digit code ) the reverse of said form should have a definition of the code ......this should be the answer you seek and based on this, you will know how to approach the company to resolve .

[Premchand1976]

& if guardian resident tuner agent eh like MY statements, I will retract them.
as soon as guardian settle all my o/s claims they never paid & never gave a reason for not paying in writing or otherwise
, furthermore, make that eveybody. But they eh go do that, cuz they would go bankrupt if they did
If ANY guardian agent eh like MY statements, they could bite big stone & sip lanate as far as I concerned

Who is your agent ? Do u have copies of the denied / unfair settled claims ? I can try to assist .......I can try.

[88sins]

& if guardian resident tuner agent eh like MY statements, I will retract them.
as soon as guardian settle all my o/s claims they never paid & never gave a reason for not paying in writing or otherwise
, furthermore, make that eveybody. But they eh go do that, cuz they would go bankrupt if they did
If ANY guardian agent eh like MY statements, they could bite big stone & sip lanate as far as I concerned

Who is your agent ? Do u have copies of the denied / unfair settled claims ? I can try to assist .......I can try.

I don't need or want you to try to assist, & I didn't make that post looking for you to assist either. But since it seems you'd like something to do...


For starters, what I'd like you to do, & all others in your chosen line of employment as well regardless of what company, is:
1-Be open, honest, direct, straightforward in what you tell ppl,whether on-line, on the phone, via email or in person & not hide the fact that paying provider claims is not something that ranks high on many insurance companies priorities to do list, especially on policies where they haven't received so much premiums that their payouts exceed what they've made form the client, whether group or individual.

2-If a policy says "XX% coverage on prescription drugs" & a patient is prescribed Panadine by their physician, don't try weaseling out of paying on drug claims like a rat in a garbage heap by saying the prescribed drugs could be had OTC, so they don't count as prescription, so you pay less on those or sometimes not at all. Those were the drugs written as prescribed by the attending physician or surgeon. Pay in full the agreed percentage on the claim.

3-The way some ins. companies come to their "reasonable & customary costs" that they base their max payouts on is disgustingly deplorable & needs to be changed.. Work on that.

4-Call things what they are, as they are, when they are. A person comes seeking to initiate a policy, whether group or individual, whether life, health, annuity, tax savings incentive, investment or whatever, show them the key areas and aspects that could negatively affect them, the client. Don't just give them a 27 pg contract with print so fine that an ant needs a magnifying glass to read it, all the while hoping to God & the devil they just sign like thoughtless automatons just because an agent says it's standard & everything is in order & they'll be taken care of.

If yuh want something to do, do those.
Now, doh get meh wrong , I have neither love nor hatred, favor nor ill will for ins. agents or their clients. I just absolutely refuse to have anything to do with certain specific ins. companies
& get this, I've had an easier, more productive & smoother relationship dealing with NIB than I've had with some ins. companies, gl included.

[Premchand1976]

So you eh read and research for yuhself Bai ????? In this day and age ??? Nah man.....nah man....nah man.

[agent007]

I’ve had personal experience with Beacon and Guardian when it came to individual company medical and Guardian came out a lot better than Beacon in almost every measurable way. In terms of individual major medical, there is a maritime agent who is waiting on my business more than two years now wrt an Admed plan. Hear this, the agent says NO BILLS necessary. Just show proof that either you need the procedure or did the procedure and Maritime will cut the cheque one time. So if anyone can bring more info on this would be great, thanks!

[88sins]

So you eh read and research for yuhself Bai ????? In this day and age ??? Nah man.....nah man....nah man.[/quote]
What happen bai beta? the lil small tasks I assigned you too much for you to handle?

You ever went to the doctor and ask the cost and when you declare you have insurance, the cost change upwardly ?

Only when telling them to bill the insurance company, which is hardly ever. For me, anything upwards of 50K, bill the ins., under' I pay cash & claim it back.
Now, why you think that the cost climbs upward when people say bill XXX ins. company? Well since you want to act like yuh eh know, I'll spell it out for you.
It's because insurance companies like to play dotish & pay claims if and when they feel, & the physician/clinic is out the costs in the meanwhile until God knows when, oftentimes having to write it off as a loss, that being the only way they get any value from those unpaid claims.. You have ANY idea of what it is to send in 100 valid claims valued at 100K after bearing 30-50K in costs, & up to 4 years later still not have them settled? or only a handful of them settled, some not even in full, & have to w/o the balance?

Who supposed to absorb that cost? In this kind of case, gl collecting their premium steadily & planning on increasing it when the customer makes too many claims (so they happy), & the patient, your client, done get service & product without paying the clinic/physician or paying very, very little (they satisfied) . So the only one in this that gets left in the lurch is the dr/clinic. So what you want them to do, seeing that they not getting their money on time or at all. Leave it so & wait until if ever they get paid? Run on hopes & dreams & unicorn farts? Tell their creditors & staff to they now supplying labor & materials for free? They will charge the ins co. a fee for a credit facility the ins co is abusing. & that is EXACTLY what it is, the moment the ins company breaches it's own contract, said contract is null & void & unenforceable and any customer visiting the dr or clinic & asking them to bill gl is asking to use gl credit facility at that dr office or clinic. So they see your clients on credit ,& charge gl a fee for it.
Credit ain't free, & neither is time. Don't like the dr or clinic doing this? good, hear what, stop breaching your own contract, & pay the ppl blasted claims on time & in full, simple as that.



Now, about that schedule of benefits.
yuh want to tell people exactly how allyuh does come up with the maximum payout for surgical procedures & office visits or should I?

[RedVEVO]

Life Care from General is the best.

Always get prompt attention and quick refunds .

It is the rave !