Do You Know What You Are Getting When You Buy Health Insurance?

from OurFuture.org:




Do You Know What You Are Getting When You Buy Health Insurance?

By Monica Sanchez
April 3rd, 2009 - 2:24pm ET


You many consider yourself a very savvy consumer. You may have researched all the best advice on how to choose a health care plan. You may have even scoured the National Commission for Quality Assurance report cards on the plans available to you. But you still would not know what you are getting when you enroll in a plan.

You would know the basics of course. Do you have a deductible? How much do you have to pay for a specialist doctor visit? Does the plan cover chiropractic care?

What you wouldn't know—too often even if you called to ask the plan directly—is under what conditions it covers the specific care you may need. Just because a plan "covers" a certain medical treatment or service doesn't necessarily mean it will cover it when you need it. It is covered only if the plan considers it medically necessary for you at the time you request it.

How do they decide what is medically necessary for you? That is the $64,000 question to which we can't seem to get an answer. At least not from the private health plans. .........(more)

The complete piece is at: http://www.ourfuture.org/blog-entry/2009041403/do-you-know-what-you-are-getting-when-you-buy-health-insurance

when I was unemployed I had zero insurance.

Which more or less knee-caps the whole argument about "competition."

But we already knew that.

That's my experience anyway. That's why I have the HMO. The PPO plan left me too exposed. Even with the insurance I could be bankrupted by a major illness in short order. With the HMO, my copays are minimal, my max out of pocket is something like $2500, and there is no maximum benefit or if there is I'll be dead before I get there.

the way those contracts loop around -- in and out -- you go to the hospital -- and BINGO! -- your insurance doesn't cover that -- but you gotta have it.

who didn't know.

A good SECer, using the principles of the securities acts, would rip one of those plan disclosure docs to pieces and tell the insurance company not to come back until they have read the laws and regs.

as with ANY insurance policy.

Potential care minus profit equals the care they deliver. So even the best plan is 'what you bought, minus our cut'. If health is possible after the profit is taken, then care might be delivered.