Questions & Opinions

December 12, 2006 by bob.

I devote a lot of time to freely answering questions in public forums, both live and on the web. One thing that always baffles me is the number of folks who want answers from people who lack experience & training in specialized fields. Recently I ran across the following question on a site for programmers.

Q. I’m a self-employed programmer who is about to become a father. Previously, my family’s insurance has come through my wife’s employer, but she is eagerly looking forward to being a stay-at-home mom. We must look for that elusive low-cost insurance in order to enable her to do this. Losing her insurance is not a huge loss as, due to failed negotiations, the hospital in our city (3rd largest city in the state), along with most of the doctors that refer to it, is dumping the network (largest in the state) that our insurance uses. On the individual coverage plan front, my research shows story after story of deception, fraud, and general run-around or obfuscation by most of the major players and nearly all the minors. With all of the bad experiences out there, I’ve yet to see a good review of an insurance company. What does the Slashdot crowd use and recommend? Company and plan-type? PPO? HMO? HDHP + HSA (High Deductible Health Plan + Health Savings Account)?”

A. These are certainly fair questions, but unfortunately they are posed to the wrong people.

The individuals who frequent this site are computer programmers, not health insurance experts. Further, health insurance is state, and even region specific. The loss of the PPO network providers is specific to his state and city. Insureds in other states, or even other areas of the state will be immune to his particular problem.

The comment “I have yet to see a good review of an insurance company” is biased. Most who comment on carriers do so in public forums and only use the forum to vent their frustrations. Most of the time the complaint is generated by a lack of understanding of the way insurance, or their particular policy, works.

Most of the “fraud & deception” can be attributed to uneducated marketers of health care products who are selling to an uneducated consumer. Consumers are easy targets who are constantly looking for the “best deal” and unfortunately, that is where they are subject to being defrauded.

And, most of the complaints revolve around either of two issues. My premiums are too high, or, they did not pay my claim.

In most (but not all) cases the premiums are too high because the individual bought the wrong kind of plan. The spread between what people want their plan to do, and what they can afford, is often canyon sized. This is because they fail to understand why they need health insurance. It is to pay those claims that are financially impossible to cover out of income & reserves. Nothing more, nothing less.

As for claim denial, this too is a lack of understanding of what they bought. Most individual plans will not pay for treatment of a pre-existing (or related) condition. There are also restrictions on coverage when you go out of network, or have procedures done that are extra contractual.

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