What your insurance company may not be telling you about high deductible medical insurance

High Deductible Health Insurance coupled with a Health Savings Account (HSA) is becoming a popular way to reduce insurance premiums and therefore medical expenses, but are insurance companies giving you all the facts when they sell you a policy? Mine did not. Is this a case of consumer fraud?

The law that created this type of insurance made a change to terms that had a defined meaning, and legal precedent. The deductible stated as Individual/Family no longer means what it always had. A high deductible medical insurance policy sold to a couple or family, has only one deductible, the family deductible.

For the requirements for this type of coverage, click here. Look for the section titled "Important Note About The Family Plan Deductible".

As an example I will use my experience with Anthem in Connecticut. When purchasing a high deductible policy that met the legal requirements to establish an HSA I was not informed of the change to the meaning of "Individual/Family Deductible". My family consists of myself and my spouse. To lower our expenses I purchased an HD policy on March 1, 2006 that was labeled as $2500 Individual / $5000 family. Never was it mentioned in the advertising or the application process that our deductible would be $5000, with no ability to ever receive the $2500 individual deductible. We found this out when my spouse went in for a preventative medical procedure that we assumed would put us over our deductible and we would not have to pay the entire bill. This was 8 months after we purchased and received the policy.

When I, and then my spouse, called Anthem we received the answers "There is nothing we can do." and "It's the law.". One Anthem customer representative felt that we were right and said that she would "correct it". When I did my own research I found that it was the law. We never did hear from the customer rep that had agreed with us.

I had worked in the insurance industry for over 12 years, albeit as a programmer and many years ago, and I had never heard of the new deductible definitions.

Why do I consider this consumer fraud? Insurance companies and the insurance industry employ a large number of attorneys. Insurance companies know of this change. Is the average American expected to research law when buying a policy? Is the average American expected to learn auto mechanics when having a car serviced? Must I study medicine before I see a doctor? I feel that it is the obligation of the insurance industry and individual insurance companies to inform consumers of changes to accepted policy terms.

My policy cover states "Century Preferred Direct HSA Subscriber Agreement $2500 Deductible - w/Rx". My approved application sent to me had Item # 3:

3. Plan Choice

Product Name: Century Preferred Direct HSA (PPO)
Deductible: $2500.00
Optional Prescription Drug Coverage (no charge after deductible): YES

Would the average consumer expect this to be a $5000 deductible policy? I think not.

I would like feedback. Is this one insurance company or are other insurance companies using this tactic? Is this only happening in Connecticut?