Dear Stop-Loss: A Ballad

By: Jon Jablon, Esq.

 

Author’s Note: Written in ballad meter, this can be sung to the tune of “Gilligan’s Island.”

 

You carriers are sometimes great,

all flexible and fair;

But sometimes you issue denials

That make me lose my hair.

 

Prevailing charge in the area

is what the policy allows;

Yet when presented with a claim,

some of you break your vows.

 

An auditor has been brought in

to reprice the group’s claim

based on Medicare or cost…

But carriers: for shame!

 

The promise to strictly abide

by the policy

goes out the window, and quickly

becomes a fallacy.

 

Each and every claim that’s denied

must be supported by

the policy your groups have bought

when they did apply.

 

All carriers must use good faith

in everything they do;

making things up as you go

is legally taboo.

 

To cap your risk with those objective

methodologies,

make sure you always use good faith…

Revise your policies!

 

When an employer signs with you,

you’re expected to pay out

benefits you have promised

in the policies you tout.

 

The whole entire industry

is worse-off when you fail

to follow your own written rules;

in court, you won’t prevail.

 

The Phia Group is here to help

all those who have been harmed;

info@phiagroup.com

You’ll never be unarmed.