What good is health insurance if it doesn’t work? - KCTV5 News

What good is health insurance if it doesn’t work?

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Do you have health insurance or something else? It’s a question we’re now asking after investigating why a healthcare claim was rejected. (KCTV5) Do you have health insurance or something else? It’s a question we’re now asking after investigating why a healthcare claim was rejected. (KCTV5)

What good is health insurance if it doesn’t work and you have no real coverage?

Adam Warman will be the first to tell you he hates dealing with health insurance.

"Basically, I was throwing money everywhere. What is the use of having it?" the Independence father questioned.

Warman bought an insurance policy. It wasn’t terrific, but he was trying to avoid paying penalties.

"I was only able to afford myself and kids, and my wife went without. She works from home, so I told her to be careful walking around," he said.

But, Warman says he hurt himself and had to go.

"I was lifting up a box, pushed in my side ... felt like it ripped open," he said. "Called insurance company ... sure you are OK to go."

Now, he is stuck with an $11,305.40 hospital bill that he can’t afford. In addition, he must tack on another $829 for the doctor.

So what happened? The fine print on his insurance policy says “no benefits are payable for sicknesses which arise during the first five days following a covered person’s effective date.”

Warman’s urgent care visit was coded at Saint Luke's Health System as an illness, not injury. So, the insurance company rejected the claim. Now, he’s stuck with that bill.

"I did check first. I checked to make sure .. I couldn’t afford it any other way," he said.

Warman is angry with the hospital which won’t recode his visit.

Saint Luke's says they’re stuck. If they try to reclassify the visit to satisfy this limited policy that would be insurance fraud.

KCTV5 News sat down with an insurance expert who says the real problem here is Warman's plan is just garbage.

"That's not a health insurance plan," insurance broker Cary Hall said.

Hall says skyrocketing health insurance plans have created a terrific opportunity for fly-by-night insurance companies to sell rotten plans that are designed to fail, and they are disguised for the average consumer as health insurance. However, they aren’t.

Warman bought a medical indemnity plan he found on the Internet. It is a protection for loss when it comes to medical expenses.

KCTV5 took a closer look at his policy. It states that it will never cover:

  • Most hysterectomies
  • Tonsils
  • Adenoids
  • Nasal and sinus surgery
  • Eardrums
  • Any hernias or gallbladders
  • Myringotomy
  • Tympanotomy
  • Herniorraphy
  • Cholecystectomy

And then there’s an even longer list that excludes any mental health treatment. Also, if it’s an extreme-sport activity, there is no coverage. And, if you have alcohol or drugs in your system, they will boot that claim too.

"Call an agent or broker ... is this a legitimate health care plan?" Hall recommended.

Hall says a better path for some families is to buy legitimate catastrophic health insurance that is available and will cover you in case of a real emergency.

"It's real health insurance. It's not one of these fly-by-night scams you are seeing on the Internet or getting robo calls for," Hall said.

It’s information that comes too late for Warman who questions what healthcare has really come to.

"I would rather go back to 1930's dental floss and needles and sew up our own wounds. It's crazy," Warman said.

So what can you do? Read the fine print on your insurance policy. There are more and more exclusions being written into policies.

You can also go through a broker. You don’t save a dime if you buy insurance directly from a company.

And finally, consider catastrophic coverage. They are much cheaper than traditional insurance, and it makes sense for some families.

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