Shocking Truth About Health Insurance Coverage: Are You Covered?

Health insurance is one of those hot-button topics that folks love to complain about but seldom do anything constructive to change. We keep hearing stories (anecdotal or otherwise) about people working past a traditional retirement age so that they can qualify for health insurance. Since I am self-employed, I’m on the hook for my own insurance.

Last Fall, we received yet another notice from my health insurance carrier that my rates were going up. Having not had any type of claim in something like six years, I decided that their practice of routinely jacking up my bill was not going to happen again. It was only then that I embarked on a very interesting journey to secure a new health insurance provider, who would grant solid coverage at a better price.

While I would clearly describe myself as an optimistic person, I must level with you and say that I had no preconceived notions that I was about to get “something for nothing”. After doing some analysis and a little research, it occurred to me that my current health insurance policy featured a deductible that was way too low. Amazingly enough, had I stayed with my old provider and simply adjusted the deductible, I still would not have saved a whole lot of money. Needless to say, I was glad to rid myself of my old insurance company.

Given the wonderful technology age we live in, I wanted to replace my health insurance coverage by doing all of my shopping in cyberspace.

Filling out a few fields online did not phase me, but I should have become suspicious when one of the pieces of information that was requested was “telephone number”. Yes, instead of getting several quotes for health insurance over the Net to choose from, I was the proud recipient of telephone calls from health insurance agents.

As it turns out, the website where I filled out the application shared my “sales lead” with Lord knows how many health insurance agents.

It began the day after I filled out one of the online forms. These health insurance agents were circling like vultures, desperately wanting to get their foot in the door to sell me their wares.

Altogether, over a several day period, I’m sure that there were less than a dozen health insurance providers who contacted me. (My darling wife will try to convince you that there must have been more than that, based on the number of times she had that disgusted look on her face as she handed me the phone.)

As much as I wanted to be able to conduct all of this health insurance business over the phone or Internet, I quickly became resigned to the fact that it probably wasn’t going to happen that way.

Early on, a very affable guy (that would be a euphemism for “fast-talking slicky dude”) found a way to “bond” with me, and we set up an appointment to meet in my home a short time later.

My first mistake in this process was not doing some online research in advance of this health insurance sales call. It is easy for me to claim that there just wasn’t enough time. Trust me to not make that mistake again.

The health insurance salesman acted like a very nice guy, as opposed to many I‘ve encountered. The fact that he drove such a snazzy car is testimony to his ability at salesmanship. He sold me on the fact that his health insurance policy was designed for the self employed, and actually had an “Aflac-like” feature, which would pay me cash for each day that I might be hospitalized.

When I took into consideration the higher deductible, my premiums for this health insurance policy were going to be lowered substantially, with seemingly equal or better coverage.

While he left me with a small mountain of brochures describing this health insurance, it did seem that some of the paperwork he had shown me during his “dog and pony show” found its way permanently into his briefcase. I would have enjoyed being able to take a second look at some of that documentation. This was not something that I lost sleep over, as I knew that I’d have time to rescind the policy in the event that I found any “red flags” upon its arrival.

Had there not been more health insurance “vultures” circling in hopes of making a sale with me, I might not ever have conjured up any suspicions about the quality of the coverage that I had just purchased.

When one inquiring mind politely asked with whom had I decided to purchase my health insurance policy, he told me “that he had gotten a lot of people out of that awful policy and on board with him.” He proceeded to describe in graphic detail some of the shortcomings of that policy.

One of my staunch axioms is that you should never denigrate the competition. If you don’t have anything nice to say about somebody, don’t say anything at all.

In this case, I have to confess that his comments may not have been unjustified. When I “Googled” the name of my new health insurance company, I came up with a variety of articles detailing some horror stories that a huge number of people had with respect to their coverage, many of which ended up in court.

The moral of this story, before I even get to the end of it, is to READ YOUR POLICY. I don’t care how dreadfully boring you may find the typical health insurance policy to be, I actually analyzed mine, and found the following shocking details about my coverage.

Under the category “Surgeon Benefit” it said the following: “Covered Expenses incurred for services by the Physician performing Surgery.

If two or more Surgeries are performed at the same time through separate incisions, We will consider the one providing the largest Benefit. We will also consider 50% of the Benefits otherwise payable for the other Surgeries performed at the same time.

We will not consider more than one Surgery performed through the same incision during the same operation; however, We will consider the Surgery providing the largest Benefit.”

When I spoke to a customer service person with the insurance company, she confirmed that if I had, for example, multiple injuries from an automobile accident, then they would pay on an 80-20 basis for one of those procedures. The balance of the procedures performed would leave me “on the hook” for at least 50% of the costs. Considering what surgeons, anesthesiologists, surgical nurses, etc. charge, it is not difficult to imagine why so many of this companies insured’s had complained demonstrably when they received crippling medical bills after having a major medical event.

No wonder when I conducted a Google search of this insurance company’s name, I read an absolutely heart-rending story of a family that was left in financial chaos after a cancer surgery and treatment.

Never mind the fact that the salesman used all the correct buzzwords to describe his product, upon further review, I was not going to be receiving the coverage that I thought I was getting.

Never mind the fact that many of the problems that other people were having over the years may actually have been rectified by now. I know exactly what I was reading in black and white in my policy, and I know it was something that I wanted no part of. My salesman clearly misrepresented the coverage I was receiving.

It was amazingly easy to unwind this policy. Every cent that I had prepaid was cheerfully refunded in a very timely manner.

Surprisingly enough, when I ultimately got my health insurance coverage with the new provider, everything was handled over the phone, in as painless a manner as you could imagine.

My only reluctance in naming names here is the fact that over the past several months it is entirely possible that this nationally known company has in fact cleaned up its act completely, and may offer health insurance policies that are in line with everyone’s expectations. If you’d really like to know who they are, feel free to email me at the address here on my blog. After all, what’s a little health insurance talk among friends?