The health insurance industry is in the business of making money – not covering your health problems. In fact generally, the more “affordable”, the greater the “advantage”, the “better” the deal, the “cheaper” the plan, the less you get covered. The health insurance industry is about the only insurance industry that “covers” routine care and then takes you for a fool.

Health plan tactics to minimize payments.

  • You pay for your routine care anyway with copays, deductibles, non-covered services and any pre-existing issues.
  • Plans are marketed using misleading terms. 
  • Plans have terminology that’s difficult to understand.
  • Plans are confusing by design.
  • Plans are impossible to compare.
  • Plans are riddled with loopholes, limits and exclusions.
  • Plans use endless barriers such as “referrals” to limit access to care.
  • Commonly have narrow provider networks.
  • Use non-medical intermediaries for “authorizations” to delay, ration or deny care.
  • Limit testing and often recommend cheaper options, i.e. ultrasound instead of MRI to limit payouts.
  • Have “preferred” drug lists – you get cheaper drugs so they save money.
  • Have cost limits for drugs.
  • Deny tests or treatments claiming they are experimental or unnecessary.
  • Subject consumers to post-claims payment reviews.
  • Commonly use agencies to review claims and claw back payments.
  • Unilaterally and systematically deny coverage.
  • Explanation-of-benefits or EOBs are ploys to explain why payouts were limited.
  • Explanations regarding provider payout “allowables” are ploys to mislead.
  • Plans often discriminate against women.
  • Commonly, only about 50 percent of premium dollars are paid out on medical claims.
  • Brokers are compensated more for selling junk health plans.
  • Be wary of “individual”, “managed care”, “cobra” and “fixed benefit” plans and medical discount cards.
  • Not all health plans are equal – even large insurance companies sell junk plans.
  • Healthcare “ratings” are unreliable.
  • The health insurance company’s allegiance is to their shareholders – not patients.

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Written by HEALTHdrum