Lawmakers Find $21 a Week Doesn't Buy a Lot of Groceries

[Munchkin03]

Originally Posted by AGDee

In reality, few insurance benefits are easy to get as some people believe. For example, when I worked in mental health and someone's insurance company said they had to leave an inpatient psych unit after 5 days, they would say "But my policy says I get 30 days". They didn't realize that you only get as many days as they decide you need. If someone documents in your chart that you smiled when you are supposed to be depressed then BAM, you're outta there.

But, isn't your story more an example of people not properly reading their policies? Mine clearly states that I have a 30 day MAXIMUM for inpatient mental health care as determined by a physician. People do this all the time--for example, thinking they have a $15 copay on all of their doctor visits, when it's really the only ones in-network.

Most people think you can just mosey up to a VA hospital and get full benefits when that is hardly the case. However, I doubt many people think that they're going to get the full benefits from their HMO/PPO.

[AlphaFrog]

Originally Posted by Munchkin03

But, isn't your story more an example of people not properly reading their policies? Mine clearly states that I have a 30 day MAXIMUM for inpatient mental health care as determined by a physician. People do this all the time--for example, thinking they have a $15 copay on all of their doctor visits, when it's really the only ones in-network.

You and I read our policies - and in fact I've read TONS of policies (but then again, being HR for my company, it's my job). But the average person does not. Especially the fine print like "as determined by a physician".

[AGDee]

The other phrase I find interesting is "80% of the expected and usual cost" or something like that. It's not 80% of what your doc charges, it's 80% of what they think most docs should charge...