5 Things Health Insurance Companies Don't Want You to Know

By Robert Lewis, InsWeb.com

Health insurance companies aren't in the business of keeping secrets, but some aspects of health coverage aren't always as clear as consumers would like. Here are five things health insurance companies may not want you to know:

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#1: Out-of-Network Expenses Are Often Denied

Health insurance companies will usually only cover out-of-network costs under special circumstances, such as:

  • An in-network specialist isn’t available locally
  • You receive emergency care from an out-of-network hospital
  • The insurer has given you permission, in writing, to use an out-of-network provider

#2: Some Health Insurance Companies Won't Cover Therapy

Many health care plans exclude or limit access to mental health services. Depression and bipolar disorder don’t get the same treatment as, say, cancer and heart disease.

Alternative care services like homeopathy, acupuncture and massage therapy are also iffy.

#3: Denied a Claim? Challenge It—You Just Might Win

If you contest a denied claim—and if you fight hard enough—you've got a good chance of winning. A 2003 study by the Journal of the American Medical Association found that roughly 50 percent of medical necessity disputes are overturned.

Remember to always send correspondence by mail so there’s a clear paper trail.

#4: Generics Are Often Just as Good

Generic drugs usually work just as well as brand-name drugs, but the price is astronomically different. For a generic drug, the average co-pay is $11; the average for a “fourth-tier” brand-name drug is $89. Always ask your doctor if a generic drug is available.

#5: Individual Health Insurance Is Often Cheaper Than Group Health Insurance

If you’re relatively healthy, individual health insurance probably costs less than group health insurance. Employer-based plans cover employees regardless of health. This, in effect, means you are paying higher premiums due to the unhealthy habits of others.

Health insurance companies offer widely varying premiums. In fact, rates can vary by as much as 50% for similar plans, so it pays to shop around. Compare health insurance plans today.

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