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What is a Health Insurance “Junk” Plan?

Rhonda Sandel

By Rhonda Sandel

CEO, Texas Emergency Care Centers, and Board President, TAFEC

When you sign up for an insurance plan, you are entering into a contract with a health insurance company.

You are agreeing to pay a monthly premium and certain deductibles and related plan costs in exchange for medical treatment and services; this includes legally protected emergency care in your time of need.

Unfortunately, many Texans are finding that the insurance plans they are paying a lot of money for in exchange for important coverage are turning out to provide far less. In essence, they are left holding the bag in the form of a “junk” health insurance plan.

This is particularly the case when Texas consumers need emergency medical care. Increasingly, before even getting the opportunity to receive the care they need, patients are being manipulated by their health insurance company and find themselves redirected (i.e. “steered”) to a lesser care option the insurance company wants to cover (no matter the ultimate cost to a patient’s health and wellbeing).

And when patients aren’t being manipulated on the front end, they are being manipulated on the back end of care when their insurance company informs them that in their professional opinion, the emergency care they sought was not necessary—despite what an emergency-trained physician determined in an emergency care setting.

This all stems from a growing trend in the health insurance marketplace: “junk” health insurance plans. It boils down to this—when consumers are buying a health insurance plan, they are intending to buy protection for themselves and their families. And yet, health insurance companies are doing everything they can to not pay for legitimate ER care (even when a consumer’s plan very clearly covers that kind of potentially life-saving care).

There are multiple things wrong with “junk” plans—while they often don’t cover what the patient was expecting, they still cost a small fortune. They lead to financially harmful outcomes—patients receive a “surprise” bill from their health insurance company (with the awful surprise being their surprising lack of insurance coverage); this leads to patients being on the hook for much larger bills than they were expecting or should be receiving. And ultimately, these “junk” plans have consumers thinking twice the next time they or a loved one may require life-saving care. That is the most egregious effect of these inadequate health insurance plans.

This often happens because health insurance companies are “Monday morning quarterbacking” when it comes to your ER care. While your health insurance plan should always cover your care in a medical emergency, insurance companies are changing the rules (and violating the law) in the process by claiming that they get the final say on whether or not you should have gone to the ER.

The push by major healthcare companies to discourage what they see as “unnecessary ER visits” is at the core of the “junk” plan revolution. When did insurance companies get the idea they know an emergency medical situation better than the patient who is experiencing it?

This manipulation needs to stop at once. The Texas Department of Insurance has been made aware of examples of this kind of health insurance shortcoming and the effect it’s having on patients. Texas Legislators are being made aware, as well.

Tell us your story at MyEmergencyMyChoice and we’ll make sure that TDI and your elected officials in the Capitol know that you’ve had enough of “junk” health insurance plans and other forms of manipulation by your health insurance company.

Has Your ER Claim Been Denied?

If your visit to the emergency room has been denied by your insurance company, or you feel they didn’t cover enough of the costs, we want to hear your story. 

Additionally, have you called your insurance company when you thought you were having a medical emergency and they told you to go to the urgent care? This is patient steering and we want to hear from you.

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