Workers from El Toro Cement Company (Cemex) who retired after more than 35 years of employment were denied their insurance coverages. The denials and increase in premiums were deliberate and superceding progressively in their attempt to discourage ex employees from using the original contract with the employer and its insurance administrator. The program started with Aetna as its only insurance benefits extending into retirement age. El Toro Cement Co. continued to change insurance companies with almost two to three times the original premiums.There are only a few survivors left,but are paying up to 400.00 dollars per month for health insurance. The Cement plant was eventually shut down and sold to its Mexican counterpart in Juarez, Mexico.
I have been in the insurance business for 43 years. When you consider the fact that most companies administer their own plans, it is always a conflict of interest in my opinion. The only other method of providing service is through a Third Party Administrator hired by the company to process and pay claims. This also produces a conflict of interests because the administrator will use the parimeters that the hiring company sets. I truly don’t think there is a way to avoid this conflict…Does anyone out there have any workable ideas how this can be avoided?
Yes, I can’t see how this differs from any other kind of insurance, where the insurer both decides the liability, or coverage availability, and also is financially on the hook.
I am a Metlife employee. I have had two experiences with the disability department. The first for one surgery was excellent and w/o incident. The second was a nightmare. On both, I returned to work according to doctor instuctions. On the second, after 4 weeks of “review”, they decided I should have returned 4 weeks earlier and denied my claim. Appeals were useless. The fact that I couldnt drive was disregarded because there were “other forms of transportation”. It was a ridiculous excuse to short me on deserved benefits. I am not done with the appeal process and intend to see a lawyer.
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Workers from El Toro Cement Company (Cemex) who retired after more than 35 years of employment were denied their insurance coverages. The denials and increase in premiums were deliberate and superceding progressively in their attempt to discourage ex employees from using the original contract with the employer and its insurance administrator. The program started with Aetna as its only insurance benefits extending into retirement age. El Toro Cement Co. continued to change insurance companies with almost two to three times the original premiums.There are only a few survivors left,but are paying up to 400.00 dollars per month for health insurance. The Cement plant was eventually shut down and sold to its Mexican counterpart in Juarez, Mexico.
I have been in the insurance business for 43 years. When you consider the fact that most companies administer their own plans, it is always a conflict of interest in my opinion. The only other method of providing service is through a Third Party Administrator hired by the company to process and pay claims. This also produces a conflict of interests because the administrator will use the parimeters that the hiring company sets. I truly don’t think there is a way to avoid this conflict…Does anyone out there have any workable ideas how this can be avoided?
Yes, I can’t see how this differs from any other kind of insurance, where the insurer both decides the liability, or coverage availability, and also is financially on the hook.
I am a Metlife employee. I have had two experiences with the disability department. The first for one surgery was excellent and w/o incident. The second was a nightmare. On both, I returned to work according to doctor instuctions. On the second, after 4 weeks of “review”, they decided I should have returned 4 weeks earlier and denied my claim. Appeals were useless. The fact that I couldnt drive was disregarded because there were “other forms of transportation”. It was a ridiculous excuse to short me on deserved benefits. I am not done with the appeal process and intend to see a lawyer.