How to Tell if Your Health Plan is Substandard

They pay 80% of a "reasonable cost" and your remaining cost is MORE than they paid.

Your doctor's home and office is a van in the parking lot.

Directions to your doctor include "Take a left into the trailer park."

They don't cover prescription pain medication because pain relief is not medically necessary.

The bottle of leeches next to the water cooler...

You are enrolled in "Bob's HMO Plan".

HMO considers child delivery an out-patient procedure.

They define a pre-existing condition as "any illness or injury you have ever had, or any family member has had, or any condition you have ever heard of."

Tongue depressors taste faintly like fudgesicles

In the exclusions section of your benefit booklet it says "no coverage for services ending in -ostomy, -otomy, -ectomy, -plasty or -ization."

They don't cover hospital stays except for heart-lung transplants, and then only overnight.

"Dependent care" is defined as "depending on whether or not they want to cover you".

The other "patients" in the waiting room are a cocker-spaniel and a parrot (Norwegian blue)

When the annual deductible is greater than the lifetime benefit cap.

Coverage only good three days of the week, they won't tell ya which days.

The only "approved doctor" operates in an alley and goes by the street name "Dr. Feelgood"

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And true tales of horror...

A window fell on my hand. I got a letter from my HMO that said they are going to sue the owner of the house where I was injured to recover the cost of x-rays and treatment. I am the owner of the house.

Your doctor's receptionist says "Oh my God! That's the highest co-pay I've ever seen!" and your doctor says "This prescription is cheaper if you don't go through your insurance".

In the birthing room, middle of a BIG contraction, the phone rings. It's the hospital business office; "Your health insurance co. says you're not covered for this". A little late, doncha think?

During subrogation of car accident medical bills, my insurer wanted to be reimbursed for claims they had denied.

The health plan will pay for fertility procedures, but will not pay for contraceptives. However, it *will* pay for Viagra.

When inquiring whether my dental plan would cover repair to a tooth I chipped on a rock I encountered during lunch in the corporate cafeteria I was informed that they take no ownership of the rock and it will be classified as an "Act of God"?!?

You have to actually lose limbs to receive benefits.

I pay $100 a month for the privilege of paying up front for all services and prescriptions, submitting my own claims, and having them denied.

Emergency Room visits had to be pre-approved by the Insurance Co. for coverage authorization

While checking in for day surgery the hospital asked for my health insurance plan, then wanted payment in advance.

A British friend working in California told me that the small print on her health plan translated as, "If you fall ill, you will be deported".