Things Your Health Insurer Isn't Telling You

Health insurance is often complicated, with a seemingly endless variety of plans to choose from, all with their own particular loopholes and problems. Over at SmartMoney.com, they have put together a round-up of things your insurance company may not be telling you.

Among the items on the SmartMoney list:
“Your deductible is only the beginning.”

Consumers typically assume that once they meet their health plan’s annual deductible, the plan pays the rest. Not true, says Nancy Metcalf, a senior program editor at Consumer Reports Health, who notes consumers still often have to kick in thousands of dollars in co-pays and other expenses. And those costs seem to be rising. The average out-of-pocket medical costs hit $3,091 in 2006 (the most recent data available), up 26% from 2001, according to the Center for Studying Health System Change in Washington.

“If you fight hard enough, we’ll back down.”

Don’t assume that because your insurer initially rejected a claim that it won’t eventually pay up. You just need to fight harder…
Persistence often pays off. About a third of the contractual disputes were overturned, and about half the medical necessity disputes were reversed… The Affordable Care Act will provide consumers with a formalized way to appeal and will create an external review process.

“Our reputation isn’t what you think it is.”

A brand name – or a national presence – may not mean much when it comes to health care coverage. Because plans vary by state, an insurer’s plan may be radically better in one area of the country than another… Companies like Aetna, Kaiser, and Group Health, which administer plans across the country, are highly-rated in some states, poorly evaluated in others. Meanwhile, some of the top-ranked insurance plans – like Capital Health Plan, Geisinger Health Plan and Tufts Associated Health Maintenance Organzation – aren’t nationally known at all.

10 Things Health Insurers Won’t Say [SmartMoney.com]