For Clients: How Insurance Companies Undermine Your Care
The reality of it the insurance industry is absurd.
Your insurance company takes your money via a monthly premium and then they want you to pay for the service you’re seeking.
And when you desperately need the service, they come up with a million reasons to not pay for it. Then you end up paying for the service anyway via co-pays, co-insurance, and deductibles.
And they disguise this with their made up jargon—co-pays, co-insurance, deductibles, premiums, pre-authorization, authorization.
For therapy and other mental health treatment, maybe your struggles weren’t deemed “severe enough.” Or, your “authorized sessions” run out. Or, the cost per session your insurance company gave you was actually much more. (Yes, sometimes they cannot even tell you the correct amount you will pay when seeking a service. How is that even possible?)
They collect all your diagnoses and use them against you in the future to make your monthly premiums more expense—even if the diagnosis wasn’t correct or justifiable.
Let’s not forget the pharmacy. Your medication is $50 with your insurance. The pharmacy could sell it to you for $10. But because you have insurance, you pay $50 and your monthly premium.
It’s understandable to want to use your insurance. You pay for it and it should support your health. But the system was built around a medical model focused solely on reducing symptoms, not improving overall wellness. And one of profit—the one that labels mental health struggles as “disorders” to be treated with short-term, manualized, interventions to save the insurance company money.
Maybe you haven’t experienced all of these frustrations. Maybe your insurance covered a surgery or a visit to the emergency room (which often can be negotiated if you self-pay). Some individuals truly benefit from having health insurance. And many of us don’t.
So do the math for yourself based on your healthcare needs. It might just be cheaper to not have insurance.
Here’s a list of insurance jargon you may run into:
Premium: The amount you pay monthly.
Deductible: The amount you must pay your self (out-of-pocket) for covered services before your insurance company begins to pay.
Out-of-pocket: The amount of money you pay directly for services that is not, or only partially, reimbursed by insurance.
Co-pay: A fixed amount you pay for a covered healthcare service at the time you receive it with your insurance covering the rest.
Co-insurance: The percentage of the cost of a covered healthcare service that you pay after meeting your deductible, while your insurance covers the remaining percentage. BUT, you often pay 100% of the service until you hit your deductible.
High deductible health plan (HDHP): Insurance plan with a lower monthly cost (premium) but has higher out-of-pocket costs that you must pay before your coverage begins.
Health Savings Account (HSA): Savings account used to pay for qualifying medical expenses, available to those with high-deductible health plans.
Pre-authorization: Approval from your health insurance company is required before you receive certain services or medications.
Authorization: Approval from your insurance company for a specific service, procedure, or medication for it to be covered under your plan.
In-network: Healthcare providers or facilities that have a contract with your insurance company.
Out-of network: Healthcare providers or facilities that do not have a contract with your insurance company.
Emphasis on the word “covered” in these definitions because some services insurance companies refuse to pay for, meaning they are not “covered.”
