US Healthcare Insurance Industry: "Confusion will be my epitaph".
Just like the story below, the broker came to our house and offered us what seemed like a great plan. Only to find out later that it was very limited coverage, all buried in the fine print and which the broker never divulged. It took the passage of the ACA (Obamacare) before we were able to afford a reasonable insurance with proper coverage.
The Insurance industry, particularly healthcare insurance, in the US is one of the biggest scams perpetrated on the American people: Bureaucracy of Kafkaesque vintage, rip offs, endless run-around confusing communications, denials, rise in premiums, flooding the consumer with incomprehensible bills, sudden unexplained terminations of coverage, periodic revisions of coverage with minute details that make no sense (like we will cover spine surgery for the cervical vertebrae, but not the thoracic ones!) and through which we have to go through every year (at about this time of year) like a detective with a lens and a microscope to discover where the new scams are hidden.
And yet, we are bombarded by the Republican and MAGA crooks with the fallacy that the US healthcare system is the best in the world and that regulating it like President Obama did is against the "American way of life" i.e. against the traditional rip-off of millions of captive people whose greatest fear is not to go bankrupt because of illness. Only morons who voted for Donald Dumb believe this fake patriotic crap in which the scammers wrap themselves with the American flag while they are ripping you off.
=================================================
NC woman canceled her ‘health insurance’ — then $12K in charges hit her card. Why regulators say they’re powerless
James Havers
Mon, October 27, 2025
Elizabeth Gildersleeve thought she’d purchased a legitimate major medical plan through a company called Cambridge Health PHCS.
When Elizabeth Gildersleeve canceled a health insurance plan that let her down, she thought her troubles were over. Instead, her credit card kept getting hit again and again, resulting in charges that eventually totaled around $12,000.
“I got to tell you, I lost sleep over it,” Gildersleeve of Charlotte, North Carolina, told local station WBTV. (1) “It was like a kick to the gut.”
She thought she’d purchased a legitimate major medical plan through a company called Cambridge Health PHCS. What she actually got, according to state officials, was either a limited-benefit plan — a type of coverage that may only pay a small amount for a small number of conditions for a short period of time — or completely fake.
And when she called North Carolina’s Department of Insurance for help? They couldn’t step in.
“These are not licensed insurance companies,” a spokesperson for the North Carolina Department of Insurance told her. “The plans don’t fall under our jurisdiction.”
A $12,000 mistake
The trouble began in 2023, after Gildersleeve’s husband switched to contract work and the couple lost employer-sponsored coverage. When she checked the Affordable Care Act marketplace, the premiums looked too high.
“I decided that I didn’t want to do that,” she said. [Iznogood: She probably was brainwashed that Obamacare is a Socialist plan! I wouldn't put it past a North Carolinian]. She began looking into other options.
A representative for “Cambridge Health PHCS” suggested a policy that “met all the criteria for Obamacare.” It sounded legitimate.
Then came reality.
“I had to have an MRI and I was told it would be paid at 70%,” Gildersleeve recalled. “Come to find out they didn’t pay anything at all.”
She canceled the plan — or thought she did. But the charges didn’t stop. In fact, they multiplied, along with a confusing series of name changes.
“When I first got the insurance it was Cambridge Health PHCS,” she said. “At one point it was QuickHealth… When I tried to get my refund, it was called Benefits Now.”
Each name came with new charges. Some refunds appeared, but fresh withdrawals would follow days later. By the time her bank froze the account, nearly $12,000 had cycled through her credit card.
“This was just cruel,” she said.
The regulatory blind spot
Gildersleeve filed complaints with the North Carolina Department of Insurance. The regulator confirmed it had received 21 complaints about similar operations in the past five years but could not take action because the companies weren’t licensed insurers.
That’s a loophole affecting consumers across the U.S.
The National Association of Insurance Commissioners warns that short-term or limited-benefit plans “are not regulated with the same consumer protections as comprehensive health coverage” and may exclude coverage for pre-existing conditions, prescription drugs and mental health. (2)
However, in Gildersleeve’s case, her insurance plan may not have existed at all.
In May 2025, federal prosecutors charged two companies and four men accused of running nationwide telemarketing schemes under names including QuickHealth and Benefits Now. (3) The indictment says they used fake names and false ACA claims to sell discount plans to tens of thousands of Americans.
All have pleaded not guilty. Their trial is scheduled for 2026.
Why consumers are vulnerable
With health costs rising, many Americans are tempted by cheaper alternatives. The KFF reports that, on average, workers with employer-sponsored health insurance still contributed $6,296 to the cost of family coverage in 2024. (4)
For people between jobs, self-employed or retired early, ACA marketplace plans can cost hundreds per month, especially without subsidies.
That makes offers like Gildersleeve’s “ACA-compliant, low monthly payment, immediate coverage” sound appealing. But confusion between a “major medical,” “short-term” and “limited benefit” plan is one of the biggest traps in the system.
How to protect yourself
Here’s what you should do if you’re shopping for health coverage [Iznogood: These recommendations shift the burden entirely on the consumers to avoid being scammed. They have to spend time and effort playing the detective to find out if they're being scammed. Really? Take time out of my ordinary life and be on constant watch to find out if my health is in the hands of crooks? Shouldn't that be the task of government to whom I pay inordinate taxes? In order to get reasonable coverage without being embezzled, I have to become an expert in insurance and regulatory laws and do all the following?]
Verify the license. Every real insurer and broker must be licensed by your state’s Department of Insurance. In North Carolina, visit www.ncdoi.gov.
Request everything in writing. Legitimate insurers will send a Summary of Benefits and Coverage (SBC). Scammers often refuse or send vague PDFs full of fine print. (5)
Watch for pressure tactics. If they say, “‘We’re going to give you this price and it’s a really good price today. Tomorrow, it’s going to be a higher price’ — that’s a big red flag,” Barry Smith, deputy director of communications for the North Carolina Department of Insurance, told WBTV. “Insurance companies that are legitimate are not going to do that.”
Monitor your bank and credit statements. Unauthorized recurring charges are the first sign something’s wrong. File disputes immediately and contact your state attorney general or the FTC at reportfraud.ftc.gov.
The high toll of confusion
The Federal Trade Commission logged 115,473 health-related fraud reports in 2024. (6) For retirees or self-employed workers, one fake plan can wipe out years of savings and leave them uninsured when a medical crisis hits.
“I made myself a promise that if I had an opportunity to speak out and inform people, maybe somebody would not have to go through what I went through,” Gildersleeve said.
Her case highlights a painful truth: Even with watchdogs in place, regulation often stops where deception begins. The best protection remains vigilance and skepticism.
Because if a company promises full coverage at half the price, it may end up costing you everything.
No comments:
Post a Comment