When your insurance company does business by multiple aliases, you know its scamming people.
This past year, I spent $3,708 ($4,708 including the $1,000 deductible) on an insurance plan from Lifewise (a.k.a. Premera Blue Cross of Washington) that is expensive and increasingly difficult to navigate.
Beginning, January 1st, I'm moving to a catastrophic plan for $2,040 annually with a $1,850 deductible. It's much less out of pocket - even with deductible ($3,890 vs. $4,708), almost the same coverage - and I won't have to deal with the insurance company as closely.
If you're not fortunate enough to have employer-based health insurance (directly or via a spouse), you know that the so-called regulated insurance market for individuals is pretty awful.
Until Congress gets serious about health insurance reform (which it does not yet appear to be), Americans are going to continue to suffer, defenseless against this corrupt industry and its outrageous profits carved from the bodies of sick and dying people.
For now, I suggest spending as little as possible with these companies while providing yourselves with the minimum coverage and a catastrophic safety net.
Here are just a few of the ways Washington State health insurers cheat their customers:
- At my prior insurer, Regence Blue Shield, about 1/3 of my submissions for reimbursals were just never responded too a.k.a. circular filed/thrown away. I believe that Regence's policy is to throw away a certain percentage of submissions to increase profits, knowing that many people will just give up.
- Defining Deductible down. In car and home insurance, the term deductible is pretty straightforward. You pay a certain amount out of pocket, the insurance company pays anything above that amount. Premere and Regence are allowed to apply only reimbursable costs and only covered costs to your deductible.
- Paying lower or no benefits for providers certified as health professionals but labeled Out of Network by the insurance company. My new chiropractor charges $45/visit, less than my old "preferred" network chiropractor. But, he's not covered and the chiropractic benefits that were advertised to me are not extended to him.
- Unrealistic maximum payments for provider visits, below the cost of a typical charge
- Rejecting reimbursement requests. Expiring prescriptions and requiring costly, time-consuming, frequent visits to doctors before visiting specialists e.g. physical therapists. I'm waiting on two separate requests right now because of codes that the insurance company won't match up - even though all the providers are certified health professionals with legal invoices and chart notes.
- Higher and higher co-pays, now up to $25-$30 per visit
- Misleading marketing e.g. outpatient rehab (which sounds like substance/recovery services) is a term used to limit benefits for physical therapy
- Difficult to use websites. Premera recently downgraded its site making it much more difficult to use.
- Long hold times for customer service
- Vision and dental care are commonly excluded from health plans
- Dental plans have buy-in periods in which you can receive no benefits as well as ridiculously low coverage limits that don't pay for most catastrophic dental services.
