What are some common private health insurance complaints?

Like any other product or service the private health insurance industry receives its share of complaints. These are sometimes legitimate. However, a good deal of the time consumer ignorance and failure to read the details of policies is at the heart of disagreements. Knowing what the common consumer complaints about health insurance companies are is very important.

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Complaints range from what are thought to be unannounced premium cost increases to lower than expected benefits on claims filed. A thorough reading and understanding of your health insurance policy and attached schedules can often explain why what is happening is happening. The better you understand these details, the better prepared you will be and you will reduce any possible negative impact on you and your family.

The Most Common Complaints

What are the most common complaints?   Many seriously ill people would like to try treatments based on their doctor’s advice only to find that their health insurance company does not cover the treatment they seek. Another related complaint is that even after a procedure or course of treatment has entered the mainstream, an insurance company may still classify it as experimental. The much higher cost of transplant surgery, when those practices were well past their infancy, is an example of this.

Insurance companies revise their rates annually and when someone becomes ill they may see dramatically higher rates the next year.  People will sometimes complain that they are being targeted for rate increases due to their illness.

Health maintenance organizations (HMOs) are often accused of reducing benefits in the name of saving money on costs. People see premium increases and shrinking benefits as a result in some cases. There is the perception that insurance professionals are making health care decisions that they are unqualified to make and that these decisions are based solely on making a profit.

Self employed and unemployed people are not eligible for private group health insurance and thus they pay more in premiums. Some people see this as unfair.

Some states allow an insurance company to charge more in premiums to people based on their health history. Many do not. When this is done, people often feel that they are being singled out because they are sick more often. On the other hand, people with fewer reported and paid claims feel that they are subsidizing sicker people with bad personal health choices in some cases.

Often people file complaints because they do not understand the details of their policies in respect to preexisting conditions. They feel that is unfair to be denied coverage and benefits because of a lapse in insurance coverage. Still other complaints are filed by people paying more in premiums as they grow older. Others complain that after a certain age they cannot get insurance at all.

General Complaints and Perceptions

What are some general complaints and perceptions?   Some complaints arise from the fact that few people look at the itemized costs of their health care and that the health care providers see the insurance company as able to pay virtually any amount charged. This leads to the widely held belief that health care costs are out of control and that the insured are paying too much in premiums.

Some insurance companies are thought to attempt to reduce benefits or delay payments by using excessive paperwork and other requirements. There is the perception that some folks will simply give up fighting the system and this will save the insurance company money.

What to Do if You Have a Complaint

If you are wondering, “What can I do if I have a problem with my health insurance company?”, then the first thing you should do is read your policy carefully and make sure you understand its provisions exactly. You may need some professional help with this such as a financial adviser or lawyer. Another thing to do is to check with your state’s health or insurance department to see what is required of the company to see if they are following all laws and regulations. There is a comprehensive listing of all state health and insurance departments at the Centers for Disease Control (CDC) website.

You can also check with the Better Business Bureau (BBB) to see what complaints have been made against the health insurance company at the BBB website. They have a quick online process for you to file your own complaint and will contact your health insurance company to facilitate resolution of your issue.

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