
Originally Posted by
rickdugan
I just want to add that expenses aren't the only thing causing me anger. The amount of time I now must burn on insurance issues each year also really pisses me off.
For starters, every year my plan is cancelled and new options are introduced, so every year I have to go through a policy research project all over again. The first year that Obamacare mandates kicked in and my insurance company gave me a default option, I did not pay enough attention to what was happening. Big mistake. This was the first year that doctors' offices started picking and choosing which policies they would accept from the big carriers and none of our doctors would take the one we were placed in. So we ended up having to take our kids to the local medicaid pediatrician that year, who we never actually met because she ran a high volume operation that relied upon nurse practitioners for almost everything. And for this wonderful care, my out-of-pocket costs increased dramatically because of changes not only in the amounts of co-pays and deductibles, but also to what services they were applied to (including urgent care and specialists).
So now every year I have to go through a time consuming exercise of first identifying which plans are accepted by our doctors and then parsing through the summaries of benefits for those various policies in order to find one that makes the most economic sense in light of the premiums and our routine medical needs. I have a background in finance and I deal with complex documents for a living, yet I still need to devote real time and effort in making sure I understand the ramifications of each benefits package, including the fine print as to how deductibles and co-pays are applied. For example, some plans waive the deductible for urgent care clinics while other don't; some plans apply the deductible to all lab work while others only apply to lab work done outside of the doctors office; some policies apply deductibles to specialists while others don't; etc.,etc.,etc. The hide the ball games now played include cheapening premiums a hair on some policies vs. others, but then making the deductible applicable to virtually everything, which can actually make the policy more expensive if you need any medical testing or services whatsoever.
But even worse, these hide the ball games have become so complicated with my current provider, who offers so many nuanced policy versions that change every year, that even their own people often do not properly apply our benefits. I spent many more hours last year circling back to the insurance company to get them to pay claims that they initially denied because (1) they erroneously treated them as non-covered services under our policy; or (2) they improperly applied the deductible to services for which the deductible was waived in our particular policy. In many cases I was able to handle this using a simple online form, but in a few instances I had to get on the phone and deal with multiple people to get it sorted out. At one point, I learned that some of this was happening because the benefits for our policy were improperly coded in their system, so I ended up having to coax them into going to the actual benefits table in my policy document and then educating them about the benefits I purchased.
The scariest part of this, however, is that there are likely many people who buy these policies who don't understand the documents well enough to properly comparison shop or to even challenge their insurance companies when claims are improperly denied. So they end up buying policies that are more expensive in the long run and/or paying for services that should be covered. Now I am being kind in saying that these claims issues were honest mistakes, but it would also not shock me to learn that my insurer was initially denying these claims knowing that a certain % of people would not fight the denials. Now it is easy to blame the insurance company alone for this, but this whole Obamacare fiasco is the ultimate culprit as my insurance company would not feel the need to play these games if they were not losing money on these policies. I never had any of these problems with this same carrier prior to the year that the mandates kicked in.
Anyway, this is the end of my ongoing rant, lol.
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