Sneaky Things Health Insurers Do to Make You Pay More
It is a known fact that everybody needs to have health insurance. What is not known is how these companies manipulate rules in order to make more money for themselves and force people to pay more for health care products and services.
This fact applies to all companies whose businesses relate to health insurance as well, such as those who sell medical equipment, provide therapy services, sell medications and offer different types of home care.
The government plays a role, also, because they don't fund the system of checks and balances correctly.
As a result, people pay billions of dollars more every year than they realize.
Even if they do "get it", there is little most can do about it.
The Pre-Existing Conditions Scam
The goal of every insurance company is to take in the greatest amount of money while at the same time paying out as little as possible.
One of the most well known things they do is to try to avoid insuring people with previously existing conditions or, at the very least, limit their liability when it comes to paying claims.
When someone has one of these conditions, insurers will either deny coverage, severely limit it or charge significantly more for it.
Obamacare put a stop to this practice, but there continue to be challenges to it that could one day bring it back.
Don't be fooled into thinking that the health conditions they put on their lists are just the major ones such as Heart Disease or Diabetes. If you have something as simple as acne or are pregnant or have depression, it is likely you could have a problem with insurance at some future date if this nasty rule should ever return.
If it does, you, not they, will likely be paying for medical care for those problems or you may even have to pay for every health issue you have if these companies decide to refuse coverage!
Many insurers, especially HMO's, require people to get referrals before seeing a specialist.
This usually means going to your family doctor, getting the referral set up, and then using it to see a specialist.
This means paying for two physician visits instead of one (which doubles the income for doctors as well as insurers).
Interestingly, those who buy Original Medicare don't ever have to have referrals!
Unless you are lucky enough to be healthy or smart enough to be vigilant, the cost of prescription drugs, even with insurance, can be outrageous.
I know a man who suffers from a very serious case of MS. He has insurance, but each month his copay is more than $33,000. There is no substitute for the medication he takes, and it is one he must have in order to avoid having debilitating pain.
It is a well known fact that Big Pharma lobbyists pay tons of money to federal legislators so that they will not address the issues that affect drug pricing.
Other countries, such as Canada, negotiate these prices, but the US does not. There is absolutely no reason for this other than greed and corruption.
As a result people in the US pay far more than is necessary, and sometimes simply have to do without because they cannot afford the high prices!
Some drug manufacturers even have a little end of year scam they sometimes use to increase profits.
My husband uses a generic medication that usually costs us less than $4 for a 90 day supply. When he tried to renew it recently, the pharmacy said they were out of the dose he needed (25mg) because it was no longer being manufactured but could sell him the 50mg dose that we could cut in two. The cost was $25!
I balked, called the doctor, and had her send in a scrip for a substitute. That one cost $20! The reason was that it was "time release", which my husband did not need! The cost for the medication without the time release would have been less tan $4 for a 90 day supply!
The pharmacist told us that at the end of the year some companies stop producing certain medications to force people to pay more and "up" their profits. This was one of those situations.
He also told me later that the company would start producing the dose of the medication my husband normally took in mid January!
Insurance companies would not be able to create such scams if our government would negotiate drug prices!
All women who have had Breast Cancer know that they will have to pay upwards of $50 for each Mastectomy bra they have to purchase. A prosthesis can cost more than $300.
If you shop on Ebay, you can find these same items for much less, and insurers want you to buy them there because this means they won't have to pay a dime for you to have them!
Before I was on Medicare, I bought the bras for $12.50 each and a prosthesis for far less than $100.
Now Medicare pays for them, but there are millions of younger women who don't know they can spend less for them.
It isn't just items like this that cost more. Any time the word "health product" is attached to an item, the price skyrockets, even if you just need to temporarily rent something.
I needed a wheelchair last year. I could rent one for $55 per month, but would have to buy a "special" seat pillow for it at a cost of $169 and insurance would not cover the pillow!
I borrowed a wheel chair from a friend and used a $10 boat cushion instead and did just fine!
These and similar costs all exist because of how insurance companies pay (or not).
Few people actually take the time to read their insurance contracts. For many, this can turn out to be a very expensive mistake.
All companies have their own sets of pricing guidelines, which are extensive.
One glaring example is Medicare's charges for ambulance services.
Everybody assumes this is a covered item, but the truth is that they will only pay if your situation is life threatening. Otherwise, depending on where you live and how far you have to be transported, an ambulance can cost a bundle.
I live less than 10 minutes from a local hospital. An ambulance ride will cost me just shy of $700!
I know the rules and so far have been able to avoid these costs, but most people haven't taken the time to learn about them.
It pays to ask questions and review the details!
The cost of a hip surgery I had several years ago was $50,000. The surgeon got $3500, and the rest went to the hospital to pay for my room, the operating room, the services of doctors who assisted in the surgery, etc.
You can go to certain other countries and have the same operation for about $7500. I know people who have done this.
Costs are high in this country because our government requires hospitals to treat all patients whether they can afford to pay or not. The rest of us take up the slack!
Everybody charges more because insurers negotiate prices and pay far less than actual costs, which means that hospitals have to charge more to be able to make a profit.
This is why a 25 cent bandage is billed at around $9!
The Bottom Line
Beneath all of the high prices, haggling and manipulation are the insurers that provide the coverage and decide who does, and who does not, get it.
Health insurance companies want you to pay more for coverage so that you won't have to pay as much for the services and products you need, but in many cases, you end up paying anyhow because of the way they manipulate costs.
It's a cruel practice that continues only because our government allows it.
Will you contact your senator or congressman to demand that he say "no" to adding pre-existing conditions clauses into health care plans?
In doing my research for this article, which was written on May 7, 2017, I referred to the following information about pre-existing conditions:
"Measure on Pre-existing Conditions Energizes Opposition to Health Care Bill," by Alexander Burns and Abby Goodnough, New York Times, May 5, 2017.
"Pre-Existing Conditions," HHS.Gov, January 31, 2017, Assistant Secretary for Public Affairs.
"Here's a Partial List of All the Pre-Existing Conditions the GOP Bill May Not Cover," by Nicole Chavez, CNN, May 6, 2017.
"Tricks of the Trade: How Insurance Companies Deny, Delay, Confuse and Refuse," The American Association for Justice.
© 2017 Sondra Rochelle