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Celtic Insurance Company

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Celtic insurance company is a scammer
Posted by Dandmdouma on 04/02/2012
GRAND RAPIDS, MICHIGAN --
a received a letter from my former insurance carrier that indicated that they were no longer going to continue having the type of coverage that I had, but offered that we could switch to celtic as of the first of the year(2012). It sounded great and mentioned also that we were quaranteed coverage and that we could not be refused because of a pre-existing condition. By the 1st of the year came I had received a letter welcoming me to Celtic insurance along with the following:booklet of the items covered, two cards showing a certificate number, and effective date of 1/01/2012. Also, a billing for the first quarterly premium, which was paid and sent out right away because it was later in December that this information all arrived in the mail. I just found out last week that my policy was terminated on 1/1/2012. they won't really give me a reason why it was terminated. they would only gave a fax number that I could fax an appeal of some sort. I plan to do that, but we all know how that is going to go. They claim the premium amount paid will be refunded although I have not seen it yet, nor a formal written termination notice. They only told me this over the phone. apparently, I never had coverage from day one. they were not very forthcoming with me and don't seem to care about their paying customers.
     
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Response to "My 3 Cents"
Posted by Agent65 on 11/17/2009
Points of clarification.
I am an independent agent and deal with all kinds of companies. Concerning your specific issues with Celtic:

1. The extra $5 bucks. I am going to guess that you elected monthly billing and NOT EFT. There is a handling charge for the former. It is common with all plans of this type from all carriers - execpt for those who will NOT do monthly direct bill. (And there are more than a few of those)
The surcharge is clearly described in the payment options.

2. Claims handling; Celtic products are medically underwritten, and in most states do not accept most pre-ex conditions. It is a function of how carrier's have to operate within each state's legal guidelines. They may or may not request doctor's records before issuing a policy. They DO check with the Medical Information Bureau (MIB)and a similar national data base of pharmacy records. These two data bases are populated by reports submitted by various companies (Health, Life, Disabilty) and then accessed by members to verify medical history of potential clients. The data base companies do not and can not verify reports.

You have filed a claim within the first year of your policy. Company will need to verify this was NOT a pre-ex, which could potentially disqualify your policy if it is determined there was something you did NOT report on the application. It's called Fraud.

On the other hand, underwriters react to what is in Doctor records, and trust me when I tell you, I have seem many cases where the Dr. records were full of careless errors (The mystery hospital?)
Also, many cases of Dr. CYA - comments to keep them clear and yet now necessariy accurate as to waht was told to you.

3. Last but not least, Uncooperative Service Reps. They are barred by federal law (HIPPA) from discussing any personal medical information over the phone. All dialog must be in writing signed by the patient. Most often, that information will be sent back to yr Doctor and not you. Again, this is a safety measure to prevent unschooled clients from making medical diagnosis or overeacting to data (For exapmle, tests showed your BP at an alarming level) Otherwise, the company is subject to nasty fines and the representative could be quickly fired. Call your congressman - HIPPA was passed for "our privacy protection". You must know this so you don't go off on the service representative who has their hands tied.

Last piece of advice - if you are going to buy insurance on-line, then you better consider your self an expert. It is clear from your disatisfaction statement, you do not know a lot about how companies operate and what laws tie them in knots.

Next time, get a qualified independent agent who can help you through this jungle. From what you have said in your posting, Celtic is following routine procedure on claims adjudication and staying within the confines of state and federal laws.

Your rant while an expression of obvious frustration, is based on a tremedous lack of knowledge. Not your fualt - no one is expected to be an expert in this mess - bnut that is the role you took when you decided to go it on your own.

Sincerely,
Russ
     
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Posted by Mario The Great on 2009-11-17:
This was the 1st well written, (some spelling errors), response to a My3cents review. Nice to know that some people out there actually read and respond to this board. :)
Posted by goduke on 2009-11-18:
HIPAA does not say that agents cannot discuss medical conditions on the phone. HIPAA says that the agent must first verify that the person to whom they are speaking is, in fact, the patient. Once that verification is done, the agent is free to discuss any PHI on the account.

BTW...HIPPA is an animal in a zoo in Oklahoma.
Posted by agent65 on 2009-11-18:
go duke:
You are absolutely correct as to the legal wording of HIPPA. BUT, in practice, that is NOT commonly done - too many frightened people on the other end of the line. ( I wish I could have transcribed a running dialog I had with the VA one time on this issue. You would have wet your pants.)

And just between you and me, (and anyone else who reads this) I rep every legit health insurance company licensed in my state. NONE OF THEM get 5 stars in my book when it comes to Customer Service. Hell, they don't even get 3 stars. Way too often the motivation is to clear the call - move on. I get so frustrated and angry sometimes getting involved in these cases to assist my clients that I often find myself saying - "Russ - you need a new business model. Get the hell out of healthcare."

Thanks for your comment.
Posted by CrazyRedHead on 2009-11-18:
I've seen a HIPPO at a zoo, but I've never seen a HIPPA. lol
Posted by Anonymous on 2009-11-18:
Sorry guys, this is bothering me and agent if you are in the business you should know that it is not HIPPA, it is HIPAA. Health Insurance Portability and Accountability Act. If your conversation includes personally identifiable information of the patient you must have a signed release from the patient. That will allow you to discuss matters with other healthcare providers, insurance companies, and so on that have a legitimate reason or "need to know". That doesn't mean you can just swap information. You must be able to prove that the information needed to be released to provide a service, bill a claim, and so on. People in the practice should not be woried about wetting their pants as long as they are doing the right thing.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html
Posted by Disaster Worker on 2009-11-18:
I can't take this response too seriously. They are responding about medical and don't know HIPAA isn't HIPPA?

Sorry, all of us medical folks know what it is and what the initials mean!!!
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