Bike Ride Part V – Subrogation & Spite

To the typical rebuttal to the frugal way of life, and working toward our FI plans:

But, what if you get hit by a bus?

Well… I did, only it was a car.  This is Part 5.  You can catch up on Part 1, Part 2 Part 3 & Part 4.

Recap

So, I’m sure you’re just as shocked as I am that there is a part 5 to this series.  Yes, it’s now 18 months after my accident, I was told the whole thing was done over 6 months ago.  But, as we all know,  anything that has to do with healthcare in the US is an unmitigated disaster.  So, here we are.  A whole new episode, and this one is brought to you by the letter ‘S’.

S is for Shakedown

There’s a term the mafia uses: Shakedown.  It basically means that the mafia forces you to pay for  their “services”.

It works like this:

Mafia Man – “You owe us $980 a month.”
Mr Wow – ” For what?”
MM – “Protection”
MW – “From What?”
MM – “Bad Things.”
MW – “Hmm… Ok I guess…. if you’re gonna protect me from bad things.”
****  Bad Things Happen to Mr Wow ****
MW – “Hey, Mafia Man, bad things happened. Can you protect me?”
MM – “Yeah, we don’t protect from those bad things.”
MW – “WTF??  What’s the money for??”
MM – “Protection from bad things.”

Now, I’m not involved with loan sharks and shell dry-cleaning companies, no.  In my case, you can replace the Mafia Man with United Healthcare and it’s the same exact damn thing.

Let’s recap:

  1. They charged us $980 a month for premiums on a $5,000 deductible per person for a PPO.
  2. When we were uninsured, Mrs Wow went into get her prescription, the pharmacist told her the cash price would be $9.99.  What? The co-pay is $30???  How is it cheaper to NOT have insurance?
  3. We were traveling to South East Asia to do medical volunteer work.  Like any responsible adult, we went into our doctor to get any recommended vaccines.  Low and behold, United Healthcare wouldn’t cover the vaccines.  You know why?  “It’s a luxury to go on your trip, you don’t have to go, so we don’t have to cover it.”  So wait, a vaccine to a curable disease is a luxury?!?!  WTF?
  4. I get run over by a car.  I deal with all the pain and suffering.  I follow up with all the paperwork, and close the claims.  United Healthcare is no where to be seen until 6 months after I close the file, with a threatening letter about me reimbursing their expenses.  Huh?

For some reason I feel like their company values are all complete bullshit:

Compassion

Walk in the shoes of people we serve and those with whom we work.

Who in their right mind would walk in these shoes?

The company had it’s largest quarter ever in Q4 2017: UnitedHealth, the largest U.S. health insurer, reports profit that more than doubled from a year earlier.   At least I know where my premiums are going since they aren’t covering vaccines for curable diseases or covering their insured in accidents or lowering the cost of prescriptions.  You know, the things health insurance companies are… um…  supposed to do.

So, yeah, UNITED HEALTHCARE = MAFIA!  Which leads me to our next ‘S’ word:

S is for Subrogation

Subrogation, that’s a mighty big word.

Subrogation is a legal doctrine whereby one person is entitled to enforce the subsisting or revived rights of another for one’s own benefit.

What does that mean in English?  It means that an insurance company has the right to get reimbursed for the expenses it paid out.

So, what does this have to do with me, it wasn’t my fault I got run over by a car?

Well, I was traveling with Mrs Wow and when we returned home, I had a nice letter from my insurance company threatening me that I had to repay them the expenses they incurred from the accident I was in.

So let’s recap all what has happened here:

  1. I’m paying my insurance premiums to the tune of $980 a month.
  2. I am riding my bike home from work and get t-boned by a driver that wasn’t paying attention.
  3. I end up in the emergency room, where they take all my wrong information.
  4. My insurance company only pays 20% of the expenses, because the ambulance took a concussed motor vehicle victim to an “out of network” hospital.
  5. My insurance company tells me that I am only responsible to get the out of pocket expenses for reimbursement from the driver’s insurance.
  6. I have to pay my medical claims because my insurance company is dragging their feet so much that the hospital is threatening to put it into collections.
  7. I negotiate a settlement with the at fault driver’s insurance company to reimburse me for my expenses and my time.
  8. My insurance company wants their expenses covered out of the settlement that I negotiated with the at fault driver.

Can someone explain to me exactly how this works?  I pay premiums to my insurance company, then when I get in an accident that is no fault of my own, they force me to reimburse their expenses???  I understand they have Subrogation rights, but shouldn’t that be the at fault driver’s problem?  Not their own paying customer????

Now, before you think just I got screwed, we’re all screwed.  Yup, it’s in every one of your insurance policy statements, down there in the fine print.  “We have the right to sue you for reimbursement of our expenses.”  And because we aren’t allowed to negotiate the policy contract, since it’s provided by the employer, we’re all stuck with it. Think I’m kidding? It’s right there on page 60 of the thrilling page-turner that is your 200 page plan doc.

Go ahead and Click… It’s Fantastic!!!

Pleasant huh?  Apparently, this is a thing, as I’ve been talking to a journalist about a story he’s doing on this very practice.  Which leads me to our next ‘S’ Word:

S is for Systemic Failure

I’ve gotten into this a little before.  But I wanted to bring it up again.

I don’t understand how medical insurance makes sense as a for profit enterprise.  If we are forcing everyone to pay into the system, then the system better damn well cover me when I need it.  I shouldn’t have to fight to worry about how we are going to afford getting run over by a car when it’s not even my fault?

This is an appropriate quote:

Americans live one sickness or accident from bankruptcy. – President Obama

There is clearly something wrong here, and no one wants to try and fix it:

A recent Harvard University study showed that medical expenses account for approximately 62 percent of personal bankruptcies in the US. Interestingly, the study also showed that 72 percent of those who filed for bankruptcy due to medical expenses had some type of health insurance, thus debunking the myth that only the uninsured face financial catastrophes due to medical-related expenses.

After what I’m going through, I’m not really shocked.  Can you imagine?  What if I was incapacitated?  What if I wasn’t able to provide for myself anymore, and my lovely wife would not only have to take care of her husband, but also deal with this and attempt to work to pay off all the medical debt?

During the year that this happened, we shelled out over $19,000 in medical expenses, most of which is a premium to a company who is doubling their profits every year and paying their CEO $66 million in 2014.  Which in turn refused to cover basic medical care when needed, and then came after their paying customers to reimburse the company’s expenses.  Remind me again why I’m paying them?

There’s a great post over on Investing Doc, that discusses how doctors can’t get taken out to lunch by reps, yet congressmen are taking 6 figure bribes to keep the insurance and pharmacy companies raking in the dough.

Then, sadly, there’s this gem:

Single payer healthcare might not be perfect, but it seems to work in every other developed country in the world.  Plus, I hope they could figure something out with $19,000 from two healthy people, because it’s now becoming a thing to simply roll the dice without insurance.

Systemic failure indeed.  Which leads us to our next ‘S’ word:

S is for Spite

Spite: a desire to hurt, annoy, or offend someone.

It’s a very interesting word that I don’t tend to use often.  In fact, my favorite use of the word is: Spite House.  For those of you that don’t know what a spite house is, according to wikipedia: “A spite house is a building constructed or substantially modified to irritate neighbors.”   And they’re fantastic!  It’s all about people who hate their neighbors, the government or developers and build a house, or refuse to sell, just to be a pain in the ass.  I think the most popular one in recent history was chronicled in the movie “UP“.

So why bring this up?

Well… out of spite, we are now proud owners of a new stock with the ticker UNH.  Not enough to impact anything, but I figure, I might as well have my grubby hands out just like the rest of them.  They pay dividends, which I’m sure come from all the unpaid claims and rebates from providers that they don’t pass along:

Another lovely section of the plan document (I read too much of it)

So hopefully at some point I’ll get some of my money back from those MF’ers, although I’d never be happier to see a company in which I own stock go Chapter 7.  Which leads us to our final ‘S’ word:

S is for Share Holder Meeting

I can’t wait to see if I get an invite to that!!! Ha!  Mr. David Wichmann is gonna have some ‘splainin to do.

Yup, we own a little slice of my mortal enemy!

*BONUS* S is for Shithead

So, I guess we’re going to end up with an Episode 6.  I can’t believe it, this is turning into Star Wars!!!  Right now I’m going back and forth with their subrogation arm, Optum.  It’s interesting to say the least, as I put up a fight against their collections agents.  I’m definitely breaking one of our cardinal rules :

“Don’t be a shithead.”

For the time being, just call me Shithead:

30 Comments

  • Team CF April 18, 2018 at 4:49 am

    Welcome to the ugly side of insurance business! Damn, this sucks.

    Reply
    • Mr WoW April 18, 2018 at 6:19 am

      It’s a horrible experience. Absolutely horrible. United Healthcare isn’t the only one. It’s all of them. And it’s systemic. There’s no way around it but to leave the country… hmmm… I hear Holland is a nice place.

      Reply
  • DocG April 18, 2018 at 5:19 am

    I’m so sorry you went through all that. I’m so sorry we all may have to at some time. Health care is just another example of American business. We have confused legal with moral.
    DocG recently posted…Lessons Learned From Reading Personal Finance Blogs

    Reply
    • Mr WoW April 18, 2018 at 6:24 am

      American business is one thing… Most times there is a clear description of the services provided. Most businesses I don’t have an issue with. Even the hospital, I don’t have a huge issue with. Yeah, they may charge an exorbitant amount, but that’s why I have insurance. But if the insurance refuses to pay, and then tries to get it’s money back from you after they pay, what exactly is the point of insurance?

      I really wish healthcare also was more transparent with the costs. or it was standardized. And how exactly am I supposed to know what’s “in Network” or more appropriately, how does a paramedic know what’s “In Network” when they show up to the scene of an accident?

      I do really think it comes down to this question: “Is healthcare a luxury or a right?” And in this country we’re leaning more toward the luxury. Only those that can afford it, and can figure out the system have access to it.

      Reply
  • Jacq April 18, 2018 at 5:37 am

    Bummer. I don’t understand it either. Best of luck with your subrogation. Maybe to lighten the mood, Subrogation sounds like a bad pronunciation of Seth Rogan, by someone who adds bro to sentences. “Like bro did you see the new sethbrogan flick, about a nation of submarines? It’s like bro a subrogation!”

    Reply
    • Mr WoW April 18, 2018 at 6:17 am

      I had to add that video to lighten the mood. I haven’t seen that video in a while and it cracks me up.

      Who knows. Maybe something will change. Hopefully!!

      Reply
  • My Sons Father April 18, 2018 at 5:46 am

    I’ve never had a positive experience with an insurance company, but nothing to this level. Something needs to change, it is beyond me that in a country with this much wealth, we are still dealing with the BS that comes with our healthcare system. So sorry you are dealing with this.
    My Sons Father recently posted…Question of the Month: FIRE Parody & The Most FIRE Click Bait Title Ever?

    Reply
    • Mr WoW April 18, 2018 at 6:16 am

      I don’t understand it. It’s so unbelievably complicated, and it’s designed that way so that no one can decipher it and they just pay instead of dealing with it. I have no idea what really is going on. But it just feels wrong. The whole thing.

      I just can’t believe it drags on and on like this. I have a lot of pity for folks that have chronic issues.

      Reply
  • Accidental FIRE April 18, 2018 at 4:03 pm

    Unbelievable man. Or believable actually. Sorry you’re going through all that. In addition to what you’re dealing with, there’ also the thing that most of America thinks cyclist shouldn’t be on the roads and many actively intimidate us with their blessed cars. We’re basically non-person’s to most, invisible. Or an annoyance at best.

    Reply
    • Mr WoW April 18, 2018 at 6:38 pm

      Oh yeah… I’ve had people actually try to run me off the road. I mean what the hell?!?! And on a Moto it’s worse.

      People are the worst.

      Reply
  • Cubert April 20, 2018 at 4:26 am

    Oh man.. That is NOT cool. Single Payer – it will happen. And then we have to go after the hospitals, provider groups, and big pharma – the other half of the mafia.

    Reply
    • Mr WoW April 20, 2018 at 8:18 am

      Single payer may not be the answer. But it’s better than what we have now. It’s a huge mess because it’s so obscured, and we’re treating the symptoms not the cause of the issue.

      I have my own reservations about insurance in general, but I feel like it’s sort of a necessary evil.

      Interestingly, I read something somewhere that health care in the US is so expensive because health care in the US is so expensive. Stupid… But it’s so expensive to cover malpractice suits, and why are malpractice suits so large? The largest part of any settlement is the cost of continuing medical care for the issue the malpractice created.

      Stew on that Inception style mind fuck for a while…

      Reply
  • Cubert April 20, 2018 at 8:26 am

    Lol… although malpractice dollars are nothing to sneeze at, it’s a small small piece of the pie. Most of the dollars are spent on end of life care for those with multiple co-morbidities.
    Single payer may not be the answer, but it’s important to point out that there are bad actors all around causing the high cost – not just the insurance co’s.

    Reply
    • Mr WoW April 20, 2018 at 10:35 am

      Fair enough… And yeah. There will always be folks scamming the system.

      End of life care is something we could do without, at some point stuff is just a loss.

      But that’s not causing the prices. That’s just a waste of money, regardless cheap or not.

      “Just cause it’s on sale, doesn’t mean you need more of it”

      Reply
  • FIRECracker April 20, 2018 at 2:58 pm

    Wow. That sucks. So sorry to hear about that. I had no idea about this:

    ” 72 percent of those who filed for bankruptcy due to medical expenses had some type of health insurance, thus debunking the myth that only the uninsured face financial catastrophes due to medical-related expenses.”

    So what the heck is the point of being insured or working a job you hate just for the insurance? Seems like it makes more sense just to go nomadic or become an expat. We’re paying expat insurance and it jumped by 3X as soon as you add US into the list of countries. Yeesh…

    Reply
    • Mr WoW May 7, 2018 at 4:38 pm

      Oh we’re definitely considering it. It’s complete insanity here. I can’t believe we even have to deal with this nonsense. It’s crazy.

      It’s such a mess and it just gets worse and worse and worse the more you deal with it.

      Reply
  • May 7th, 2018 Features - Rockstar Finance :: Curating the best of money and personal finance May 7, 2018 at 3:00 am

    […] ★ Bike Ride Part V – Subrogation & Spite […]

    Reply
  • steveark May 7, 2018 at 5:39 am

    Wait, there is a bright side, for me anyway.
    One of my highest paid side gigs is helping corporations win lawsuits against insurance companies that refuse to pay claims. But not in the health insurance industry in my case. It seems to be more of a problem with insurance in general than being a healthcare specific problem. I’m not a lawyer but anytime anyone has a sizeable insurance claim of any kind they better let a lawyer represent them or they are going to be shredded.

    Reply
    • Mr WoW May 7, 2018 at 4:35 pm

      How sad is it that you have to lawyer up to get service that you have paid for?

      I mean WTF?? I don’t need a lawyer to go out to dinner? They just provide the service that’s been paid for.

      Reply
      • Steveark May 8, 2018 at 1:33 pm

        I totally agree with you, it is a real upside down situation. And you don’t need a lawyer to go out to dinner yet, but in another five or ten years you may!

        Reply
      • freddy smidlap May 9, 2018 at 8:53 am

        i have a good friend who was a lawyer for insurance. he had to change up as it ate his soul to defend these companies.

        Reply
        • Mr WoW May 9, 2018 at 9:15 am

          Well maybe he can use his knowledge to affect change in the system? How do we do something about this? How do we change it? I hate sitting here bitching about it and being helpless to change it… so how do we change it? Where do we start?

          Reply
          • freddy smidlap May 11, 2018 at 7:04 am

            man, i wish i knew the answer to that. i see it as the insurance lobby being so powerful it’s hard to overcome. the ridiculous cost side of the equation is not discussed enough either. my humble opinion is that you can contact your rep. or senator but i think you have to be careful how much personal angst you’re experiencing if you’re tilting at windmills.
            freddy smidlap recently posted…Travelling for Work? Here’s How I Rocked It!

          • Mr WoW May 13, 2018 at 1:05 pm

            See I think that’s a bit of the issue as well…. we all know that’s an issue, but we can’t do anything about it. So we just reserve ourselves to being screwed over. That just seems wrong to me.

  • Jonathan May 7, 2018 at 8:11 am

    Sorry to hear. Your insurance company should bring a subgrogation claim against the DRIVER, not you. In the sad state of our world, because you weren’t at fault the costs should be the Driver’s (or Driver’s insurance).

    You may need an attorney for this one. 🙁 whomp whomp. Sorry!

    Reply
    • Mr WoW May 7, 2018 at 4:33 pm

      Yeah it’s an awful awful experience. I just can’t believe that even when you are not at fault they stick it to you.

      What a crazy system we have chosen for ourselves!

      Reply
  • John May 9, 2018 at 6:47 am

    This is a sad story, but I have to take your insurance side in this. Is it not reasonable for an insurance company to be able to recover costs incurred due to the negligence of another person? Their ability to recover directly from the driver is limited, so they include language in your contract with them stating that if you negotiate a settlement, then you include their costs, so they can recover alongside you. This is actually a more streamlined process overall and is standard practice.

    I’d normally recommend people handle personal injury settlement on their own as there is little reason a lawyer needs to be involved. But your case shows how badly this can work out when someone doesn’t even consult a NOLO book. If you aren’t going to do a little research on your own while handling a legal process, then you’d be well served by a professional. A lawyer would not make this mistake, would negotiate their own compensation, along with your insurance company, hospital, etc. and you likely would have ended up with more than the $15k. You’d do yourself a favor taking a lawyer or two up on their free personal injury initial consultation to see if there is anything that might be done at this late stage and whether they’d still be be willing to pursue whatever that might be on contingency. I have my doubts, but I’m not a lawyer. If not, you might have success getting your insurance to take only 50% of the settlement. Try not to alienate the case worker who is going to decide or argue your case with those who will decide the outcome.

    My son was hit by a car while walking to school in a crosswalk with a crossing guard. There were surgeries and recovery that took more than a year to finally end (he is fully recovered), so I know the emotional journey. In the case of a child, the law here requires a lawyer and the court be involved to finalize the settlement, but I did all the work to get the settlement. It can be done, but you can’t just wing it.

    Reply
    • Mr WoW May 9, 2018 at 7:55 am

      I’m sorry to hear your son was in an accident. That’s really bad, and I’m glad everything worked out.

      I agree with you in that they should recover along side. But if that’s the case, they should be leading the charge, not waiting until the settlement has been finalized and then follow up 6 months later. I would think, that as a reasonable company, they would take the side of their insured and lead the way for someone that seldom deals with this type of issue. I mean what is the premium for, when they refuse any and all claims, and provide no service or support during any accidents in dealing with a process that is hopefully a once in a life time experience?

      I hate the fact that a lawyer has to be involved, and it’s not even really for medical claims, it is all to deal with insurance. So all this expense, and all this mess is simply so two huge insurance companies can fight, it has nothing to do with medical expenses. If our medical expenses were covered through a different source, this entire issue will go away. For health coverage anyway.

      Why is it that it’s the responsibility of the EMT’s who show up to the scene of an accident to make sure to take you to an “in network” hospital? You would think the insurance company would step up and cover that, then fight to get their reimbursement from the at fault. Don’t they have a team of lawyers on staff? What else does that $1.7B of profit per quarter cover?

      Reply
  • John May 9, 2018 at 11:18 am

    I could go on an such an epic rant regarding our health care/insurance situation in the US and that is with decent employer negotiated insurance; I feel your pain. Regarding the payment your insurance company is after, I’m not a lawyer, but I think you are going to need to give them something to close this chapter. They may argue for all $15k, if they spent more than that. But if it actually went to court (against you) they would not get that much. They do have a claim, but you also deserve something for your pain and suffering. They would easily agree to a 30% haircut, if it was a lawyer calling them and the case was not settled yet. I tried to use that and spent a couple hours on the phone talking in circles, but remaining polite, trying to get a discount and was able to get 10% off. If you are able to make your case that they should have contacted you sooner, and do it in a way that only provides mild irritation and hopefully some sympathy, I think you can get them to only take 50% of the $15k. It probably won’t be easy though, and don’t let me anchor your expectations, and don’t start there. Good luck.

    Reply
    • Mr WoW May 9, 2018 at 12:42 pm

      Completely agree, it’s a huge effing mess and no one likes it. So, now… how do we change It? What do we do to make it better?

      So, it’s come to a conclusion. And I’ll say this… stay tuned… ha

      Reply

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