WKOW 27: Madison, WI Breaking News, Weather and SportsBuyer Beware: Not All Health Insurance Created Equally

Buyer Beware: Not All Health Insurance Created Equally

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A nationwide insurance company is causing mega problems for one Madison man. 27 News found out just because it looks like insurance, doesn't mean you're covered during a health emergency. It's been an expensive lesson for Larry Smith. One, he wishes he'd learned without paying tens of thousands of dollars in medical bills he thought his health insurance would cover. Larry lost his insurance five years ago. As a self-employed, 59-year-old with a history of health problems, he found it nearly impossible to get coverage. He settled for what he believed was "catastrophic" coverage through Mega Life and Health Insurance. He signed up for a very basic policy, with a high monthly premium and an even higher deductible. Pete Daly worries about these types of plans. He's a patient advocate at UW's Center for Patient Partnerships. He says at least a handful of people have called the center complaining about Mega's coverage. "They mislead people into thinking that it's a full-blown health insurance policy," Pete explains. According to the Wisconsin Commissioner of Insurance, almost three dozen Wisconsinites filed complaints against Mega last year. Consumers complained of Mega's claim handling, denial of claims and misrepresentation. As Pete puts it, Mega preys on patients' trust in health insurance. Pete says consumers believe, "the co-pays may be different, the deductibles may be different, but they'll come through in the end for the catastrophic situations." As Larry discovered last year when he had surgery on his shoulder, that's not necessarily true. Larry's surgery cost $10,769. Mega paid about a third of that and left Larry with the $7,592 tab. Larry says he knew he wasn't getting great coverage. He pays more than $700 a month in premiums and his deductible is $3,000 a year. He just assumed all that money would be worth it if he was seriously hurt. "I didn't pay that much attention," Larry admits. As it turns out, Larry's policy does not cover doctors visits or certain procedures. According to a statement from HealthMarkets, Mega's parent company: "When Mr. Smith's coverage was issued, it clearly and specifically did not cover certain health conditions." "You still don't want to be totally unprotected. If there's some coverage that's better than nothing," Larry rationalizes. That rational may have sufficed before, but now Larry's faced with even bigger and potentially deadlier health problems--he has prostate cancer. Larry hasn't seen a doctor or received treatment since he was diagnosed last fall. He says because of his past dealings, he's not confident Mega will cover his bills. So, he's waiting until he's old enough to get on Medicare next month. HealthMarkets admits there was a payment error on Larry's shoulder surgery. They promise an additional payment will be sent and will now review all of Larry's previous claims. The Center for Patient Partnerships advises consumers double-check what their insurance policy does and does not cover before it's too late. Click here to email comments and story ideas to Vanessa Shirley