Insurance Company was wrong, but it's my fault?

This is seriously mind-boggling.

In reply to Swank Force One:

Not arguing, questioning. What is the company doing? If somebody calls in about a payment, shouldn't they review it right away instead of telling him to cash it? Why did it take a year for them to figure it out? Don't they have any liability in telling the OP to cash it?

Curiosity. I know somebody that had a very similar circumstance and he told the company to pack send and won.

Javelin wrote: In reply to Swank Force One: Not arguing, questioning. What is the company doing? If somebody calls in about a payment, shouldn't they review it right away instead of telling him to cash it? Why did it take a year for them to figure it out? Don't they have any liability in telling the OP to cash it? Curiosity. I know somebody that had a very similar circumstance and he told the company to pack send and won.

It's called a mistake. And a mistake doesn't entitle him to money he KNEW wasn't rightfully his, just like the EBT screw-up didn't entitle those people to benefits they KNEW weren't rightfully theirs.

I'm berkeleying shocked, seriously berkeleying shocked at the discussion just because it's a "big bad insurance company."

Javelin wrote: In reply to Swank Force One: Not arguing, questioning. What is the company doing? If somebody calls in about a payment, shouldn't they review it right away instead of telling him to cash it? Why did it take a year for them to figure it out? Don't they have any liability in telling the OP to cash it? Curiosity. I know somebody that had a very similar circumstance and he told the company to pack send and won.

The company is fed eligibility by his employer in this case. You try calling your insurance company administering an employer-provided plan some time and telling them that you don't want a certain claim that was submitted to them paid.

Even though the claim was submitted to them, you show as active and eligible, and your benefits allow (Ok, "allow" isn't the right word: "mandate" is) payment.

NOT paying the claim is potentially an auditing error, and we don't have a reject code in the system that says "Subscriber requested non-payment."

99.99% damn sure that the employer is actually who berkeleyed this all up during the switch from one insurance company to the next.

IF this isn't an employer-provided plan, then what should have been done when the mix-up was realized was:

1) Find out why insurance still showed the plan as active.
2) Stop giving the Ortho the old ID card. (Or have them update their system if the card wasn't presented at time of visit)

Systems will NOT generate payment on a non-active member. As long as the member is active, payment has to be made according to the plan.

In reply to Swank Force One:

Now see, that makes a hell of a lot more sense. Thank you for actually discussing. I never even considered the employer playing a role in this, and now that I think about it, my friend's circumstance didn't have that middle man involved. So the company did their job, the OP made a little interest, the employer needs to get their E36 M3 together, and the Ortho needs to retrain their billing people to pay attention. Now I learned my thing for the day!

z31maniac wrote:

Javelin wrote: In reply to Swank Force One: Not arguing, questioning. What is the company doing? If somebody calls in about a payment, shouldn't they review it right away instead of telling him to cash it? Why did it take a year for them to figure it out? Don't they have any liability in telling the OP to cash it? Curiosity. I know somebody that had a very similar circumstance and he told the company to pack send and won.

It's called a mistake. And a mistake doesn't entitle him to money he KNEW wasn't rightfully his, just like the EBT screw-up didn't entitle those people to benefits they KNEW weren't rightfully theirs. I'm berkeleying shocked, seriously berkeleying shocked at the discussion just because it's a "big bad insurance company."

I'm berkeleying shocked, seriously berkeleying shocked at your accusation that I'm against a "big bad insurance company." Unless the "big bad insurance company" has the letters "L" and "I" involved, I have nothing against them in the slightest. I think you need to step away from the keyboard for a bit...

Javelin wrote:

z31maniac wrote:

Javelin wrote: In reply to Swank Force One: Not arguing, questioning. What is the company doing? If somebody calls in about a payment, shouldn't they review it right away instead of telling him to cash it? Why did it take a year for them to figure it out? Don't they have any liability in telling the OP to cash it? Curiosity. I know somebody that had a very similar circumstance and he told the company to pack send and won.

It's called a mistake. And a mistake doesn't entitle him to money he KNEW wasn't rightfully his, just like the EBT screw-up didn't entitle those people to benefits they KNEW weren't rightfully theirs. I'm berkeleying shocked, seriously berkeleying shocked at the discussion just because it's a "big bad insurance company."

I'm berkeleying shocked, seriously berkeleying shocked at your accusation that I'm against a "big bad insurance company." Unless the "big bad insurance company" has the letters "L" and "I" involved, I have *nothing* against them in the slightest. I think you need to step away from the keyboard for a bit...

lulz at stepping away from the keyboard, hahaha.

You're right, a web site discussion is making me hate cars.

In reply to z31maniac:

Pay them back $5 too much. Let them issue a few statements showing the credit. Then call and demand they issue you the $5 check. Then don't cash it. After a while, say you lost it and please issue another. Then don't cash it. Eventually, they will have to escheat with the state (varies by state). Generally, be a PIA for $5

Will they care? Probably not. Only you can determine if the satisfaction is worth the $5.

Its not really worth the aggravation. Pony up the dough, and move on with your life.

And I really hate insurance companies.

Yeah, you're tempting fate if you don't send it back. They're probably going to ask for it more than once though, so track that E36 M3.

Cone_Junky wrote: Going for the payment plan and dragging it out should be enough to satisfy your grudge against them.

While this would probably feel good initially.. it is always best to do what is "right"

Allegedly a company agent forced the check down his throat and he swallowed the now they call him back and want back, he says they say and threaten him with .Accounting error at multim(B)illion dollar ASSglomeration hiring sexslaves in Asia as company agents.

Gearheadotaku wrote: You're dealing with an insurance company. You are ALWAYS wrong in their eyes.

This. But the bastards are still due their money back.

just me .. but I'd write them the check ... BUT I would berkeley with them for a while before I sent ... remind them that I tried to give it back a couple of times (counting the Dentist's office) and they told me I didn't know what I was talking about ..

but eventually I'd send the money

how much interest did you accrue on the money over the last year? and how much more could you earn by stretching it out over a few more months by playing phone tag with them?

Datsun1500 wrote: The easy way to solve it would have been not to cash it in the first place. You took money you know was not yours. That's called theft.

Actually it's not, and based on Ben's info, it probably would have made an even bigger mess for the OP. The only other "out" I can see is the OP giving the check to the Ortho and telling them to deal with it.

Datsun1500 wrote: The easy way to solve it would have been not to cash it in the first place. You took money you know was not yours. That's called theft.

I would not go that far. The company essentially gave him permission to cash it.

Javelin wrote:

Datsun1500 wrote: The easy way to solve it would have been not to cash it in the first place. You took money you know was not yours. That's called theft.

Actually it's not, and based on Ben's info, it probably would have made an even bigger mess for the OP. The only other "out" I can see is the OP giving the check to the Ortho and telling them to deal with it.

No.... not cashing it in the first place would have been a good way to go about it. Insurance doesn't care if you cash it or not. They aren't going to follow up with you and say "Hey! Are you gonna cash that or what?!?!?"

Swank Force One wrote:

Javelin wrote:

Datsun1500 wrote: The easy way to solve it would have been not to cash it in the first place. You took money you know was not yours. That's called theft.

Actually it's not, and based on Ben's info, it probably would have made an even bigger mess for the OP. The only other "out" I can see is the OP giving the check to the Ortho and telling them to deal with it.

No.... not cashing it in the first place would have been a good way to go about it. Insurance doesn't care if you cash it or not. They aren't going to follow up with you and say "Hey! Are you gonna cash that or what?!?!?"

Funny, somewhat related story: I worked with a kid last summer. The summer prior to that, he worked for a staffing company (so his paycheck came from company R, but he did work for company S). He always got his paycheck, no problems, then the end of the summer came and he went back to school. A week after he was back, he gets a check from company R for $3,000. My friend calls the company, says that he shouldn't have it. They tell him yes he should. He holds on to it for 3.5 months, not doing anything with it, when they call him back and say "are you going to cash that check or are you going to send it back?" He cashed it, and as far as I know didn't have any issues.

In reply to Swank Force One:

Really? Because I have gotten that phone call. (From car insurance though, so it was probably some nefarious evil-doing to make me take their lowball offer or something).

Javelin wrote: In reply to Swank Force One: Really? Because I *have* gotten that phone call. (From car insurance though, so it was probably some nefarious evil-doing to make me take their lowball offer or something).

Car insurance is different. They pay for damages.

Swank Force One wrote:

Javelin wrote: In reply to Swank Force One: Really? Because I *have* gotten that phone call. (From car insurance though, so it was probably some nefarious evil-doing to make me take their lowball offer or something).

Car insurance is different. They pay for damages.

Exactly. And cashing the check is "acceptance of the settlement terms," they wanted to make sure you weren't going to try to contest, etc.

would it be stealing if I left a note with it telling you it was ok for you to take it ? that's what the ins. co. did ... told him it was his ...........

wbjones wrote: would it be stealing if I left a note with it telling you it was ok for you to take it ? that's what the ins. co. did ... told him it was his ...........

Is it still stealing if it's from a really rich guy?