Paying lots money to a health insurance company, then still having to write a check after receiving care sounds pretty sketchy, right? What are you paying money for every month?
Even in the wake of the Affordable Care Act, the majority of Americans are dissatisfied with their health insurance plans. To help you increase your chances of holding your own with your health and your wallet, pay attention to these ways health insurance companies rip you off.
Charging high premiums to make you feel secure
When you look at your insurance plan options, one of the most obvious differentiating factors is the premium -- your monthly payment. Generally, a plan with a higher premium will have a lower deductible, the total amount you pay out of pocket for healthcare before your insurance takes over, within a given year. People who are pretty healthy often go for the lower premium, but if you expect your body to break down this year, you might be considering the higher monthly payment plan that begins to help you out right away.
Not so fast, though! Some premiums are so high that over the course of the year, you’ll be paying more than you would if you’d purchased a lower premium plan and hit the deductible. Say you choose a plan that costs $450 with a deductible of $0. Over 12 months, you're dishing out a whopping $5,400. But what if you go for the $250 plan with a $2,000 deductible? That sounds like a ton out of pocket, but after the $3,000 over 12 months, breaking your arm, getting an STD, and having a weird mole removed (we hope not!), thus paying your whole $2,000 deductible (a teeny portion of your costs for all those disasters, by the way), you’re still only at $5,000 for the year -- $400 less than with the pricey plan.
Still following? If all that stuff doesn’t happen to you, you just saved even more money. Of course, you'll want to look at the coinsurance and copays for both of those plans, too, but this quick bit of math is a good start.
Not covering out-of-network services
You're visiting friends out of state for a week, and on day two, you hurt your ankle. By day four, the old just-ignore-it trick hasn’t worked at all, and you drag your grumpy self to the doctor -- not how you'd planned to spend vacation.
The other unfortunate surprise: a few weeks later when you get your bill, you may have been charged for every penny of that appointment and X-ray -- even if you've paid your whole deductible already. This is because your insurance company only pays the docs with whom they've made cost agreements. Doctors who are out of state -- or local docs who aren’t in with your insurance company -- are getting their paychecks directly from you. So if you thought that having insurance meant seeing the doc without financial concern, think again.
Some plans do pay a percentage of that out-of-network cost, but it can be as low as 0%. This is spelled out in your policy, so read it! In a different situation, where you travel across the country for a college reunion and end up in the hospital because you thought you could still drink as much as you did in college... congratulations, your insurance is probably paying! Emergencies are covered even out of network, though that usually comes with a hefty ER copay.
Charging more for prescription drug service than the meds cost
Your doc hands you a prescription, you go to the pharmacy to fill it, hand over your insurance card, and slide the credit card for the coinsurance (percentage of the cost) and/or copay (set per-prescription amount). Did you ever ask how much the meds cost in the first place, though?
Obviously it depends on what it is, but you might be paying more than if you'd just kept the insurance card to yourself and gone with the ticket price. And that's on top of the premium you're already forking over every month, for either a separate prescription coverage plan or a general one that has good coverage built in. Unfortunately, your prescription drugs don't have price tags on them, so you have to, you know, actually ask someone. But you should really ask at a few different pharmacies, because you may find that literally the exact same medication costs $43 in one place and $249 in another, which sounds just about as sketchy as buying drugs on the street, but it's what it is!
If you have regular prescriptions, or if you’re planning some travel where you're going to need antimalarials -- something that can get pricey -- you may want to check out the prices before you sign up to pay five times as much in premiums and copays.
Excluding certain conditions or circumstances from coverage
Health insurance companies are kind of infamous for exclusions, which are conditions and treatments that they just won't pay for. Things used to be pretty bad before the Affordable Care Act, where they could say they wouldn't pay for illnesses you had before you bought the plan, otherwise known as pre-existing conditions. Say you're seeing a neurologist and taking prescription meds for migraines, then you get a new job and have to switch insurance plans. The new plan used to have a right to say they straight-up wouldn’t cover that treatment anymore.
Really... ? Because last time I checked, people’s bodies don’t exactly sync up with when they change their insurance coverage.
Now, thankfully, the worst your insurance can do is have a waiting period of some months before they'll help you out with your migraines -- that still sucks, but in the long term, they’re paying. However, they can (and usually will) entirely exclude some treatments from coverage, alternative medicine in particular -- like if you’re getting the migraines treated with acupuncture. Exclusions are spelled out in your policy (in fine print, naturally). Zooming in is worth it.
Denying claims for services
While it's not your insurance company’s fault per se, they’re not going to be investigating things that look weird on the bill your healthcare provider sends them. Did you really get tested for chlamydia twice in one day? Doesn't matter! They'll pay for one test and ignore the other one, which you're going to be getting a bill for if you don't recognize the screw-up and dispute it with your doc's billing department.
Medical billing errors, like duplicates, incorrect codes, and asking you to pay for services you straight-up didn’t receive aren’t uncommon. You need to be checking your doc's bill against your insurance company's explanation of benefits -- two envelopes you'll receive, conveniently, at totally separate times in the mail. When something looks strange, it’s on you to either pay a bunch of extra money or call your doctor's office to (politely) say, "What the fuck?!"