Worse Than the Mob: The Insurance Industry Is Organized Crime

[Bozvotros]

123. Caveat Emptor (What You Need to Know about Your Mob Insurance and Healthcare Provider)

It's simple really. You have to know exactly who your insurance will or won't cover and/or how much of their services they will or won't cover and what medical services or procedures they will or won't cover. Then you need to know where your insurance will or won't cover you and how much they will or won't cover you in which places. You have to know if you have any coverage at all until you hit your deductible or if you have any coverage at all until you hit your out of pocket maximum. You have to know what percentage of which procedure or treatment is covered. You might get the surgery free in a network facility but still pay 30-50% of the jacked up hospital pharmacy and supply costs. You have to know all providers who your network doctor might choose to be in the surgery room and whether they are also in network or you might get socked with their whole fee. You have to clearly understand the nature of your surgical procedures and what facilities they can be performed in. Your hospital scheduled surgery might be possible in an outpatient clinic or doctor's office for thousands less. You need to know what medications you need now and might need in the future and if they are on your insurance companies formulary. Then you need to know what tier they are on and what percentage is paid on each tier. You also have to know how to review your multi page bills for "mistakes" like not deducting the network deductions, double entries, services not delivered and how to appeal that wrongly figured bill etc etc. Oh yes. You will also need to know how to appeal a wrongly issued denial of payment or incorrectly paid bill.

And if you are having to choose an insurance plan you will have to know all these things on multiple plans so you can compare price and features and choose wisely, grasshopper.

See? How hard is that?

Did I mention this is a fucking national disgrace? My heart goes out to you Will. I have experienced similar struggles with the health insurance shitheels. My settlement with one after they fraudulent denied my claim cost me about $6000 or more in unrecovered legal costs. (They paid the bill. Just not my lawyer fees).