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.