Just in case you do claim, the policy includes every possible way of avoiding payment on the claim. So all the headlines in the quotes and on the front page of the policy sell you the idea of coverage. All the small print later in the policy limits and excludes the insurer’s liability to pay. It should all be so straightforward. The policy is a simple contract between you and the insurer. You pay a premium. If any of the following things happen to you, the insurer pays for your treatment. You look down the list of injuries, diseases and disorders. Ah, if only life could be so simple.
The first problem is who you want to treat you. Some people are happy to have anyone with MD after their name prod them, nod wisely and write out a prescription. Others will only accept someone with experience in the particular problem. The difference between the two can be thousands of dollars. The doctor in general practice will charge only a small fee for a quick consult. If you go to the nearest specialist and you are put through a battery of tests to confirm the diagnosis, the total bill for the same prescription could be relatively astronomical. Then we come to the question of the treatments. The quick solution is usually a drug but taking, say, a painkiller when what you actually need is surgery to relieve the physical cause of the pain. . . Well, if you want a cure and avoid dependence on the painkillers, your insurer must be prepared to pay a lot more money.
The problem with medicine is the uncertainty. Science has only progressed so far, identifying many possible diseases and disorders, but never being totally sure what the best treatment is. One of the current hit TV medical dramas is “House” where the problems of diagnosis are presented as entertainment. What the program fails to tell you is how much the hospital would bill Gregory House’s patients. All it does is show you the alarming number of very expensive tests you could be asked to pay for without any guarantee they will provide the definite answer. So, when you get health insurance quotes, try to get a feel for three key areas: what diseases and disorders are covered, who is allowed to treat you, and what are the limits on the treatments? Yes, there will be jargon, but never accept health insurance quotes at face value. Always try to get answers to these three simple questions. Most plans place real limits of your freedom of choice. In fact, the lower the premium, the less choice you will be allowed. Only the top-of-the-range plans leave you with a reasonable amount of control over what happens to you and your family. This leaves us with an irony. The rich who have least need for health insurance are actually able to buy the best terms. The poor cannot pay and are not covered. The rest scrape the barrel to get what treatment they can.