# Insurer Denies Payment to Wounded Vet



## Bill Mattocks (Jun 3, 2010)

Very sad story.  Makes me angry.

http://www.military.com/news/article/insurer-denies-payment-to-wounded-vet.html?ESRC=topstories.RSS



> *Insurer Denies Payment to Wounded Vet*
> 
> June 02, 2010
> Knight Ridder
> ...


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## MBuzzy (Jun 3, 2010)

It is very tough to hear when the system fails.  In this type of system, even a single failure is unacceptable.  Luckily there really aren't as many of these as the media would like you to believe.  Completely unexcusable though....hopefully he gets to the right person to get this fixed.  Generally, that's what it is about, getting it elevated to the right person.


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## tellner (Jun 3, 2010)

That is the bare face of the wild and free insurance industry. This is the same industry which has a policy of immediately launching aggressive fraud investigations into any woman diagnosed with breast cancer and denying benefits for "fraud" if one forgot to mention taking aspirin for headaches.

They can't be trusted to be anything but evil unless they are forced to conform to minimal standards of decency.


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## David43515 (Jun 4, 2010)

tellner said:


> That is the bare face of the wild and free insurance industry. This is the same industry which has a policy of immediately launching aggressive fraud investigations into any woman diagnosed with breast cancer and denying benefits for "fraud" if one forgot to mention taking aspirin for headaches.
> 
> They can't be trusted to be anything but evil unless they are forced to conform to minimal standards of decency.


 
I appreciate the sentiment. But go back and reread the first post. The people denying his claim are from the federal government.


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## cdunn (Jun 4, 2010)

David43515 said:


> I appreciate the sentiment. But go back and reread the first post. The people denying his claim are from the federal government.


 
The Trauma insurance is part and parcel of the Servicemember's Group Life Insurance. "SGLI is a group life insurance policy purchased by VA from a commercial life insurance company." Tellner is on target.


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## MBuzzy (Jun 4, 2010)

David43515 said:


> I appreciate the sentiment. But go back and reread the first post. The people denying his claim are from the federal government.


 
As much as I'll defend TriCare and the like....they ARE NOT the federal government.  Neither the insurance agency granting insurance to him nor the agency which grants health insurance to ALL Active Duty Personnel are "The Federal Government."  They are a private insurance company (Humana) who the government contracts to do it.  Now, we do have SOME level of oversight, but it is frightening just how LITTLE we can do to influence them in some cases.  THAT goes back to contracting law.  I have a troop now dealing with a TriCare agency and trust me, when I go talk to some representative in the TriCare office, she doesn't give a crap whether I'm a Capt, an Airman, or a Chief.....They have a job and they do it, they don't see rank they don't see uniforms.

If you want to be angry at someone, be angry at private health insurance, they even manage to screw over Active Duty occassionally.

With that said, all in all, it IS a good system in general and I'm glad to have it....but it is subject to the same beauracracy as any other insurance system.


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## crushing (Jun 4, 2010)

cdunn said:


> The Trauma insurance is part and parcel of the Servicemember's Group Life Insurance. "SGLI is a group life insurance policy purchased by VA from a commercial life insurance company." Tellner is on target.


 
This link doesn't counter David43515's statement.  Please read the article to which Mr. Mattocks linked.  If is very clear about the problems Mr. Hallberg and others have had making claims based on combat related injuries.



> Similar cases are emerging across the country about the same program, established five years ago to address the growing number of troops coming hope with traumatic injuries from Iraq and Afghanistan. U.S. Sen. Amy Klobuchar, a Minnesota Democrat whose office has become involved in Hallberg's case, called it an example of "government bureaucracy gone amok." A recent Government Accountability Office audit is critical of how claims from the program have been denied.


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## cdunn (Jun 4, 2010)

crushing said:


> This link doesn't counter David43515's statement. Please read the article to which Mr. Mattocks linked. If is very clear about the problems Mr. Hallberg and others have had making claims based on combat related injuries.


 
I have read the article. The government deals with the problem by paying a private company a very large sum of money to deal with it for them. MBuzzy says that, in this case, it is Humana. That is how the program functions. 

There is a massive comedy of errors at all levels going on here. All of it needs addressed - from the private companies administering the insurance programs through the those who won't pay for Walter Reed to have a proper record keeping system. However, the fact that the private insurance company won't release the money when the Army and Walter Reed both say he got his leg blown off in a fight says something pretty damning about that company.


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## MBuzzy (Jun 4, 2010)

cdunn said:


> I have read the article. The government deals with the problem by paying a private company a very large sum of money to deal with it for them. MBuzzy says that, in this case, it is Humana. That is how the program functions.
> 
> There is a massive comedy of errors at all levels going on here. All of it needs addressed - from the private companies administering the insurance programs through the those who won't pay for Walter Reed to have a proper record keeping system. However, the fact that the private insurance company won't release the money when the Army and Walter Reed both say he got his leg blown off in a fight says something pretty damning about that company.



I just don't want people saying or thinking that this is the military's fault.  Most of the issues like this rest solely in the court of the private insurance companies.


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## David43515 (Jun 5, 2010)

I stand corrected guys. I was just going on the info in the quoted article, but it appears that there are people here who are more familiar with the ins and outs of the program than I am. I dropped the ball.

But either way this poor guy is getting screwed. I doubt he cares by whom.


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