“I have good insurance! Why am I getting these bills? I thought I was covered!”

Whether you have ACA insurance, Medicare or a policy through your employer, you need to know your fiscal risks.


Unless you are a high ranking political pundit or have a titanium policy courtesy of a rarified corporate position, chances are your health coverage does not afford you complete protection. You may have insurance, but almost no plan on the planet fully protects you, and most insurers won’t give you all the benefits your policy includes without a fight.


The snake in the grass danger for consumers lies in our own beliefs regarding honesty and trust. We feel safer, fiscally and physically, if we feel we can rely on our insurance company. We need to believe we’ve made the right policy choice so we can sense we will be taken care of in the midst of a medical issue, whether its an ordinary doctor’s office visit or a major traumatic event. This type of emotionally imbedded trust is where the real danger exists. By believing that a billion dollar profit generator will care for you out of the goodness of its corporation’s heart, the insurer has an enormous advantage over us.


Blue Cross Blue Shield of Illinois has over 59,000 “likes” on its facebook page. Unless they are signing your checks as your employer, why on earth would you like your insurance company? Do you like the ticket scalper, or the seats? They are insurance companies, mere conduits to care, not your healthcare providers. The ones who keep you among the living deserve more of your belief than the company you pay so that you can have access to quality care.


Rather than think of your insurance coverage as a rain barrel, collecting drops of water in the form of monthly premiums that you can draw from when you need it, think of it as a sieve. Depending on the policy you have and the care you need, that sieve might have teeny tiny holes, or it might have enormous ones. Each individual should know their policy and their rights well enough to plug the holes when the insurance company decides not to honor the full extent of the policy.


If the past is any indication, the last thing anyone can afford to do is trust his/her insurer. Wellpoint, one of the largest insurance industry conglomerates, was fined in 2010 for using a computer algorithm to arbitrarily cancel the policies of recently diagnosed breast cancer patients. (http://www.reuters.com/article/2010/04/23/us-wellpoint-breastcancer-idUSTRE63M5D420100423). It simply didn’t want to have to pay for the care of its policy holders. This type of practice is so pervasive in the industry it has a name: rescission.


You should expect that your insurance company approves your service or claim and pays the healthcare provider the fair market value for the treatment you received. You should expect that the healthcare provider won’t attempt to overcharge you above and beyond your responsibility through a process known as “balance billing”. (Often it is when they don’t like how much money they received from the insurer so they try to get you, the consumer, to pay the difference).


As we tell our clients, do your best to ignore the advertising hype in every aspect of insurance. State Farm may or may not be like a good neighbor. There isn’t a green British accented lizard who will help you in a pinch at Geico. Progressive Insurance’s Flo and her store don’t exist. There is no guarantee you’re in good hands with All-State, and Nationwide is on Nationwide’s side.


As consumers, we must hold our insurers accountable. We need to protect our fiscal and physical safety by questioning every decision, every claim, every bill, every time. It may require heavy lifting on our parts as a result, but blind “insurity” can cost us everything.