The Inside Scoop: Health Insurance and Advice

Author of The Deadly Spin, Wendell Potter is a former PR employee at Humana and Cigna and currently working at the Center for Public Integrity as a senior analyst. His book reveals the inside view of health insurance; how insurers influence legislators, the public, and policy creators. Wendell Potter gives advice to insurance buyers; how to manage rising costs and what to be cautious of.

How to choose and pay for health care?
Don’t rely on what Insurance ads and marketing tell you, they don’t tell you the fine print and hidden secrets of the policy. Read the policy carefully, make sure you know what will be covered and what will not be covered and the costs; deductible, premium, co-insurance, and co-pay. Many insurance companies provide coverage to young and healthy patients. However, if you do not fit that category, you will be paying more for the same benefits, receive less benefits, or both.

Which plans to avoid?
Limited benefit plans/mini-med plans are designed better for individuals, employees of small businesses, and a growing number of big firms such as fast food restaurants. Wendell Potter believes that these policies are bogus because many plans have low premiums as well as low lifetime or yearly ceilings on coverage. Hospitalizations are not covered by the limited benefit/ mini-med plans. These plans will be terminated as well as lifetime and yearly caps on insurance plans in 2014, but insurance companies will still be trying to institute limited benefit plans after 2014.

Where can patients find reliable info?
Straightforward and dependable information can be found at Healthcare.gov or New York’s heath care policies where you can compare policies and rates.  

Do health insurance companies present valid and clear information?
Insurers must provide correct information.

Can people really afford consumer driven health care with its increasing deductibles?
Mr. Potter disagreed with consumer driven health care because the average patient was not able to afford it. This policy was created by insurance companies and large firms to transfer the cost from the firm to the employee or patient. The new health care law does not help the high and rising deductibles that many consumers pay. Mr. Potter advises that you look at your finances and know what you can spend on health care. If you cannot pay out of pocket, paying high premiums for better coverage will be beneficial to healthy and young people.

If an insurance company denies coverage, should you appeal?
Insurance companies are increasingly denying procedures and claims. All patients should know their rights to appeal and the two stages of review. If you are denied treatment you need, don’t give up, find an advocate to help you. The last thing an insurance company wants is bad reviews and will usually grant you coverage if you file an appeal.

It is very important that you or your business knows what your insurance plan covers and how to find reliable information. If you have a small business in New York or New Jersey, you may want to look into your employees’ policies to make sure your employees are getting the most out of it. If you believe you are spending a disproportionate amount on your policy than what you and your employees are receiving, feel free to speak to someone at Metropolitan Risk Advisory to help you reduce costs and risks.