The health insurance industry is in the business of making money at your expense. They are not there to make you feel better and there’s no evidence that they improve overall health. Stop letting health insurance plans play doctor. Take control away from them with cash price, customer-directed care.

Tricks used by health plans to deny care.

Here’s a short list of the tricks used by health plans to deny care and payments in order to maximize profits. The word benefits in health plan benefits is an oxymoron.

  • Using catchy labels like “advantage plans” to have you believe their plan comes with special advantages when these plans are actually a disadvantage
  • Unnecessarily complex in design and difficult to understand
  • Virtually impossible to compare health benefits plans
  • Use endless scare-tactics to encourage purchase of health plans
  • Beware the junk insurance plan – there are a lot of them – overpromise, under deliver
  • Beware of capitation plans where doctors have already been paid by the insurance plan to cover patients and subsequent payments for services have to  come from the doctor. This is a major conflict of interest and could result in delayed or denied care
  • Commonly loaded with cheap freebies to make you think you are getting extra benefits and “advantages”
  • Set up numerous barriers to access with the need for referrals and authorizations – typically determined by a non-medical intermediary working for the health plan – many of these referrals require correct codes for services attached – this also is self-serving and only provides another opportunity for delaying or denying care by claiming code was incorrect – also, these referrals often come with time limits so if a patient can’t get an appointment within the time frame, the appointment is denied and the patient has to start the request again
  • Routinely call some tests and treatments experimental, wasteful or unnecessary so coverage denied and they don’t have to pay
  • Difficult to appeal denials and difficult to reach health plan decision-makers
  • Numerous cost-shifting games – keep premiums low to have you believe you have “affordable” coverage when in fact costs (in addition to plan costs) are simply passed on to patients with deductibles, copays and non-covered services
  • Narrow provider networks – usually with providers who accept one-sided contracts and severely discounted health plan fees
  • Opaque costs for tests and treatments so you can be hit with surprise bills
  • Artificially tiered drug lists and so-called preferred lists – another excuse to pass costs on to patients – a form of discrimination

Finally, it’s not a matter of IF your health plan will screw you BUT, how often.

Visit Come join our healthcare community and discover how consumer-directed care and paying for as-needed routine care yourself can save you money.

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Written by HEALTHdrum