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Beware of discriminatory pricing by health plans

Written by Diane Archer

Under the health care law, insurers must cover everyone who wants to enroll in their health plans, but they can and might use discriminatory pricing or narrow networks to keep you from enrolling or try to push you out if you need a lot of health care services.  They stand to make a lot more money from people who are healthy than from people who are sick and need a lot of services.

There are two key ways insurers might get you to switch to a different plan:

  1. They might not have doctors in their network who are skilled to treat your health condition.  There are “network adequacy” rules that require health plans to have in-network doctors to treat you. But, you might disagree with them about the skills of their doctors. Or the in-network doctors might not be taking new patients, might have long waits for their services or be located far away.
  2. They might charge high copays to people with costly needs.  Humana, Coventry, Preferred Health and CIGNA did just that in Florida for patients with AIDS.  CIGNA has settled a complaint filed by advocates there and is reducing its HIV drug costs, which the advocates said were discriminatory. 

If you experience these kinds of practices from you health plan, please let us know, and we will do our best to get you help.

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1 Comment

  • I too agree with these comments although I would fell blessed with a 45.00 dollar copay mine is 110.00 so much for AFFORDABLE HEALTH CARE.

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