Health Care “Plan” or “Ban”?

A friend of mine, Ken, made a claim on his health insurance, had it rejected, and began digging into what his policy will–and more notably, won’t–cover. Talk about an eye opener. It was just a minor little scrape involved, nothing serious, but the incident dragged some creepy crawly issues out of the tangled web of fine-print insurance speak.

After having spent, by his estimates, about $36,000 in premiums over the past few years– covering family and employees–he took it on blind faith that if an insured party is hurt, they’ll be insured. It seems like a logical assumption to me.

Well, logic and blind faith wilt in the face of legal jargon, so we plowed through the verbiage and quickly concluded that his policy really covers nothing at all. Nothing, that is, except the profits of the insurance company.

Take work-related injuries. If you’re going to get hurt, it’s probably at work, right? Well, with the policy I was looking at, guess what? Not covered. Sorry, chump.

Outside of work, as anybody knows, Saipan’s aggressive drivers pose a threat slightly less than hand-to-hand combat does, and we don’t even get hazardous duty pay. If something bad is going to happen to you and you’re not working, it will probably be on the roads. So Ken dreamed up the most obvious case he could concoct where someone would reasonably expect insurance coverage, just to give himself some confidence that his insurance was worth something. He posed this question to the lady at the insurance company:

“If my son gets run over by a drunk driver, my son is covered, right?”

Now, this is clearly a situation in which you’d expect coverage. Right?

Well…wrong. Turns out, if an injury is caused by another party’s “act or omission,” no coverage, sucker! What then? I guess you just crawl to the side of the road and die like a boonie dog.

Oh, and if some crook knocks you over your head in Garapan for your wallet…not covered either, or so we surmised.

Nobody wants to need their health insurance, but what’s the point of paying for something that won’t be there if you really do need it? By that point, it’s too late. It’s like getting a money back guarantee on a parachute.

Some insurance companies are, of course, good to deal with. Some others, though, I wonder about. Health insurance is too important for wondering, though, and it might take a bit of reading and study to avoid a faulty health plan.

Nobody who’s normal relishes the thought of having to dig out their health insurance policy and wade through the awkward, lopsided, clumsy wording. It’s like having your eyeballs crawl over broken glass. Unfortunately, the Age of Faith crested with the bubonic plague (which probably isn’t covered by your health insurance); the devil now lives in the details, and it might be time to give that policy of yours a careful read.