Health insurance loopholes: why to always make absolutely, 100 percent sure you have coverage

Health insurance loopholes: why to always make absolutely, 100 percent sure you have coverage

Dear Health Insurance "Provider",

I put "provider" in quotations as sometimes I wonder if it's simply aggravation you provide! Yes, I know I am a lucky person to even have health insurance despite the obscene amount of money we pay, as self employed people, to have your policy. I am all too aware of that and yet, you deceive me. You act as though things are covered when sometimes they are not. I'm calling you out on this one.

So, I need a wig. Actually in medical terms it's called a "cranial prosthesis". No one in your customer service area has a clue what a cranial prosthesis is. Teach them. We are all trying really hard not to dare say "wig". If we do, we risk you thinking we are just making a fun purchase right along with that stripper pole for our bedroom and light up spiked heels.

I don't want to wear a cranial prosthesis. They suck. They itch. They annoy the living crap out of me. Oh yeah, I had to wear one ten years ago for almost a year when I was bald. Cause that's what happens when you go through chemotherapy. You're bald and sick and want to kill people. And may I repeat I was not swinging around on a stripper pole with a purple wig.

So when I called you and asked of you provided coverage for this prosthesis you sent me a secure document with the answer. Because you couldn't just tell me on the phone after being transferred around 500 times. And in that secure document it stated that wigs were covered for the treatment of disease. It's under medical equipment and it says you'll pay up to $2,500. Wow, I was psyched. You see, I want a HUMAN hair wig. Last time when I had a synthetic wig - well, let's just say I forgot it was fake when I put a curling iron to it. A HUMAN hair wig will make me feel just that, more HUMAN.

Despite receiving this very official, super secret document, I thought hmmmm. I should probably just call to make sure of the procedure for filing this claim and be 100% sure that it's covered. The first time my fake, singed wig was not covered due to a loophole so call me crazy, I just wanted to be sure!!

The average person may not have been so adamant about the specifics. Someone may have read your document and proceeded to just buy a wig, send in a receipt and never expect the stinging reply of you only cover up to $500 for a wig, human hair or otherwise. It only took me five customer service representatives at five separate times to finally tell me the truth about this loophole. And I am sad and sorry to say, she was the only one who spoke perfect English.

So, $500. Okay. Upsetting but I would deal. But she then explained that it had to be bought from an "in network" provider. Well okay! That's good too since my deductible has been met with my $48,000 in medical bills so far!! Yippee!! No wait, there aren't any providers in my network for a million mile radius you say? Aha!! Now I have it figured out.

People rarely use their out of network deductibles so mine has barely been touched. So if there aren't any in network providers and I purchase a wig you will "apply the amount towards my deductible" and hence NOT PAY A CENT. Bravo, well played.

You have successfully developed a way to say you provide coverage and don't. You are banking on people not delving any deeper into your plan and accepting what you say on the surface. This is deceitful and misleading and you will continue to get away with it. And never lose a single nights sleep about the women who are losing their hair and just don't want to lose an arm, to pay for a wig.

Loopholes indeed. Well, I'm off to go swing on my pole.

Thanks for nothing.

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