Your health insurance: Are you getting what you pay for?

MICHAEL J. MAURER

ThisWeek Staff Writer



When a special committee of the Ohio legislature finished work this month, it failed to answer an important question: Are Ohioans getting what they pay for when they buy health insurance?



To explore the answer, ThisWeek, with the help of journalism students from Otterbein College and The Ohio State University, spent five weeks reviewing more than 5,000 insurance filings by more than 94 insurance companies since 1996.



The review found virtually every insurance company operating in Ohio is protecting its own interests at least potentially at the expense of its injured customers, who are buying insurance that they expect will protect them from devastating loss. In some important circumstances, it does not.



The issue is so complex that few ordinary consumers understand it, even in the unlikely event they read their insurance contracts in the first place. The bottom line is, if you are severely injured by someone else, Ohio law may require that your health insurance company be "made whole" for its expenses before you are made whole for your loss.



As one attorney told the commission, when people first become aware of this problem, after it is too late for them to do anything about it, they nearly universally ask, "If that's what the law is, what's the premium for?"