When It Comes to Health Insurance, People Don’t Know What They Need

December 2, 2014

Lisa FreemanToday’s guest post was written by Lisa Freeman, Board Member for the Connecticut Center for Patient Safety.

There are many options for health insurance plans now, because of the Affordable Care Act. In my experience, however, many people do not understand how complicated it can be to get what they need.

A case in point: my friend Donna.

Recently Donna had to sign up for her employer-supported insurance. She was given three days – yes, three days – to choose between 10 different health plans. Because she had a preexisting condition, she had specific coverage needs.

Donna needed to know exactly how coverage for a specific medical service would be handled. Because, the answer would affect how the deductible, copayment, and/or coinsurance would be applied in each of the ten plans. The financial implications for each varied and she needed to know exactly how much her coverage would cost her.

Yet her employer HR consultant could not answer her questions. Instead the consultant told Donna to call the insurance company itself for an explanation. I decided to come to the rescue. I have experience! (She’s lucky to have me).

The first person call center representative hung up on us. First she told me she couldn’t answer my specific coverage questions and I should call the broker – yes, the same person who couldn’t answer Donna’s questions. I pushed back a little and asked if it would be possible to speak with someone in underwriting– CLICK!

From Frustration to Success

When I called back, I was able to speak with someone who took the time to find out the answer to Donna’s specific question about the medical service she needed. Donna was able to pick the most affordable plan that would cover this life-critical service.

It shouldn’t be this confusing. So few people are adequately trained to help those of us who are spending thousands of our own dollars to make the best and most appropriate decision.

There has to be a better way. I am health literate and still find it to be a daunting process.

  • We need simplicity.
  • We need to be able to compare apples to apples.
  • We need fewer annual changes in what the policies offer and fewer variables.
  • We need help.*

This system must be serving someone well, but it is not the customer.

When signing up for health insurance everyone runs the risk of having little idea of what they should be asking, whom to ask and the potential for the decision to cost thousands of dollars. The best guess we all make could be a disaster.

*A Note from the Connecticut Health Foundation

Like Donna, do you need help? If you don’t have a Lisa in your life, check out some of the resources to get started:

If you know of others, please add them in the comments.

2 Responses to When It Comes to Health Insurance, People Don’t Know What They Need

  1. Michelle says:

    I totally agree with Lisa. It shouldn’t be this confusing! I have an advanced degree in health and have worked in the insurance industry, yet I found researching a plan to cover myself and my husband to be very frustrating. We are both contractors, so we pay the full premium. This year our premiums are more than doubling, yet we aren’t even getting coverage for the few specialist visits we need to make annually. The lowest cost plan I could find only covers PCP visits for when we get sick. We don’t even go to the doctor when we are sick, we only go to manage current medical conditions that are stable with diligent follow-up. NONE of the plans I reviewed met all of my needs, or even close to them, inspite of the hefty price increase. Some plans covered generic meds, some had no med coverage, and the deductibles and coinsurance varied widely and without justification. It was as if each plan was designed as a means to trick consumers out of getting comprehensive care. It is really maddening. I support universal health care, but the way it is being executed is awful. In addition, when I called one customer service rep at a large health plan rather than offer input or advice she just kept badmouthing “Obamacare” saying that was why the plans were so confusing. I find this a bit hard to believe. Insurance companies don’t have to be so deceptive, and they certainly don’t need to have their representatives mudslinging vs. helping consumers.

    • Lisa Freeman says:

      Your experience is like so many others and you are so correct. Many of us are paying more and receiving less. We need to demand greater healthcare transparency and accountability, something that we are currently working on. I encourage you to continue to share your experiences by writing a letter to the editor, contacting your legislator and joining us at CTCPS. We represent the patient voice; supporting you and others like you by making sure that your voice is heard and represented.

Leave a Reply

Your email address will not be published. Required fields are marked *