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[dflprincess]

162. They can continue to charge copays

Out of pocket maximums generally refer to deductibles, not copays unless you have a really good policy but that will cost you in premiums. And, they can continue to decide something is "not covered" whether you are in network or not.

The for-profits (maybe some nonprofits as well but my experience has been that the for-profits are always worse), like UnitedHealth Group, will also continue to play games with paying claims knowing that most people might make one or two calls when a claim is denied but after that give up and pay the bill themselves.

And don't kid yourself that they don't have plenty of ways to hide that they're exceeding the MLR. The odds that they won't get caught are in their favor and when it does happen, the fines will be considered part of the cost of doing business.

Given that most medical bankruptcies are filed by people who thought they were "covered" I have no doubt that the number of people having to do that will continue to climb. It's the uncovered costs that drive people to it.

I used to work at UHG and one thing that would shock the executives in the Taj Mahal (as headquarters was called) is the number of employees that became believers in a single payer system after seeing how they operate.