Consumers are confused about their health insurance policies (Singe 2009). As a result of not understanding their health insurance policies, consumers file complaints with their state health insurance commission (or department of insurance). In about 10 months, consumers filed 2,050 written complaints about their health insurers, in just one state (Singe 2009). This number was typical and in line with previous time periods. In approximately 66 percent of the complaints, consumers believed that the health insurer had wrongly denied their claim or had paid too little. For example, one man filed a complaint stating that he had received an annual physical exam from an in-network provider. He believed that his health insurer would pay 100 percent of costs for health services rendered by in-network providers. However, according to his health insurance policy, the maximum benefit for an annual physical exam was $200. The charges for the man’s physical exam totaled $275. The state’s insurance commission determined that the health insurer had paid correctly per the policy’s benefits; the man had to pay the remaining $75. According to the state’s insurance commission, this scenario is typical. In most cases, the health insurance claims are paid correctly; the consumers misunderstand their benefits (Singe 2009).
If you have never experienced this, do some research finding an article that discusses consumer misunderstanding of health benefits.