From The New York Times By Walecia Konrad, Feb. 18, 2011
WENDELL POTTER is a 20-year health insurance veteran who served in top public relations jobs at such firms as Cigna and Humana. Now a senior analyst at the Center for Public Integrity, Mr. Potter has written “Deadly Spin,” a tell-all about practices of the health insurance industry. The book chronicles insurers’ attempts to influence legislators, policy makers and the public, as well as his own change of heart about his work.
We asked Mr. Potter what consumers can do about rising health care costs and about practices they should be wary of. His responses, below, have been edited and condensed for space.
Q. Knowing what you know about how the industry works, what is the most important piece of advice you can offer readers when it comes to choosing and paying for health insurance?
A. I would encourage people to completely ignore the marketing materials you receive from the insurers. The information is geared to persuade people to buy the product. It doesn’t explain the benefits clearly.
If you’re trying to buy insurance in the individual market, you should know that those insurers are looking to sell coverage only to young and healthy people. If you aren’t particularly young or healthy, you’ll be charged more or have limited benefits or both. And even if you get insurance through your employer, you need to read carefully.
In either case, always ask the insurer or your benefits department for a copy of the actual policy you’re considering. Read it, and find out what the benefits are and what your financial obligations co-pays, co-insurance, deductibles, premiums will be.
Don’t expect everything that you need will be covered in the policy. Things like maternity benefits, transplant coverage and of course experimental procedures may be excluded. That’s the kind of information you will never see in the marketing materials, but it’s vital to making your choice.
Q. What kinds of policies should consumers avoid?
A. I’d be wary of these so-called mini-med or limited-benefit plans. These are sold largely to individuals or through small employers, but we’re also seeing more big companies, such as fast-food chains, offering these plans.
This is fake insurance, in my view. Most policies have low premiums but also unreasonably low annual or lifetime caps on coverage. Some don’t pay for hospitalizations.
The health law eliminates these plans in 2014, when no lifetime or annual caps on coverage will be allowed, but in the meantime these policies trouble me a great deal. And the insurance industry will lobby heavily for more flexibility to offer limited benefits even after 2014. So, be on guard.
Q. Where can people find straightforward information on available policies?
A. Before the new law, it was virtually impossible to get comparable information on various health plans. But now you can get lots of useful information at www.healthcare.gov. For instance, you can plug in your information and get some preliminary comparisons for rates from different insurers in your area. This information will get richer as time goes on.
In addition, most state insurance departments are ramping up their efforts to offer consumers more and better information. Always check your state’s Web site when you’re choosing health insurance.
READ THE FULL ARTICLE HERE: https://www.nytimes.com/2011/02/19/health/19patient.html