What You Need to Know About Health Insurance Part 7

Note: This is Part 7 of an 8 part series that is also being published in the Chester County Press.

“Coverage Even When Your Plan Says No”

In our last article we explained your healthcare plan’s essentially unlimited right to deny coverage and payment for the care your doctor says you need. However, we also pointed out that the contracts (Provider Agreements) that give your plan that authority are equally explicit in requiring providers to render denied care free of charge so long as it’s been prescribed as necessary healthcare by your doctor. That’s right, the provider has to provide it, but they can’t bill you for it.

Now I know this right to free healthcare has to come as a shock because it’s the furthest thing from what the healthcare insurance industry and their in-network providers would have us believe. But buckle up, because there is an even greater shock coming.

Because your plan’s power to deny coverage is based on an ability to contractually bar providers from billing anyone for the care your plan rejects, your plan is simply assuming its providers will find a way to avoid supplying free healthcare. Not a bad assumption since none of us know to even ask for free care. However, if you 1.) Understand the availability of this free care and 2.) Know that the laws of every state require a licensed provider to supply care whenever there is an offer to pay for it, you can readily turn the tables on your plan. You can simply demand your right to pay for the denied care under state law and then sign anything they put in front of you promising to pay. However, after receiving the care and getting billed for it, you simply return the bill marked “This is an unenforceable debt, don’t bother me again.” And, it’s over. Simply put, an in-network provider can’t legally bill you when they have earlier surrendered the right to bill you by signing their Provider Agreement. Much as one can’t sell a house twice.

The beauty of this approach is that you are doing nothing more than collecting the coverage you were promised and enforcing the terms of your plan’s Provider Agreement, i.e., a single Agreement that applies to essentially all forms of health insurance “plans,” regardless of their acronym. Which leads us directly into the next article.

See Other Articles in the Series