By Noah Rue

Medical insurance is one of America’s biggest scams. You pay obscene monthly fees for a deductible you can’t afford anyway to put toward medical costs that are only so cripplingly high because every system associated with it is for profit and under-regulated. Medical bills account for a high, but debated number of American bankruptcies, which cripple a family’s access to loans, bank services, and even employment.

Quality of care is going down, costs are going up, and many of us are feeling the pinch. This is, unfortunately, just the broad strokes of how broken the system is. What happens when you take a private, profit-driven industry like insurance and make it the primary caretaker of people’s health?

A whole lot of despicable behavior, that’s what.

Gouging You on Low Deductible Plans

People who have regular medical costs, or expect a large cost over the course of the year often choose to pay higher premiums in order to reduce their deductible. When you’re doing the math, though, remember to factor in the total cost of the plan over the year and compare it to the deductibles of cheaper plans. Sometimes the higher cost plans will be more expensive than even a high deductible, but they feel worth it because you’re not paying all at once.

Network Coverage

This is a favorite way to screw over customers. For example, if you visit and in-network hospital and see an in-network specialist, you’re not safe from the insurance company’s “out of network” fees. Why? If you need an additional healthcare professional or specialist that isn’t specifically covered, your in network hospital trip could end up costing way more than expected. One out of network specialist, even at an in network venue, can complicate the entire situation.

Up-Selling Plans you Don’t Need

One big problem with a for-profit medical system is that it’s impossible to know if insurers and medical professionals are recommending things out of good faith. They want your money either way.

It’s important to be an informed and discerning consumer. An insurer might try and sell you medical travel insurance, but do you really need it? Are you likely to spend time abroad? If you are, for how long, and how much risk are you comfortable with? These plans can be very useful, but they’re certainly not worth it for a large number of people.

Incomplete Service Coverage

What insurers consider necessary and not necessary can be a frustrating exercise in stupidity and futility. For example, many insurance plans won’t cover mental health services, and they’ll try to use that “not medically necessary” excuse to get out of paying for procedures that they’ve already told you they cover.

Unlawful Hidden Fees

Yup. We’ve officially moved out of “terrible but technically legal” territory into straight up illegal bull crap to get extra dollars out of you.

According to the Center for Public Integrity, court cases have uncovered hidden, illegal fees that some insurance companies charge you and your employers. Blue Cross Blue Shield of Michigan, for example, had been adding hidden fees to hospital bills since 1993 and was ordered to pay one of the companies they were gouging $6.1 million.

Making Things Confusing

One of the big reasons that it’s so difficult to work out what and when you’re covered is because insurance companies would really rather you not know. The rules around networks and covered procedures are intentionally opaque. That way, they pay out less. It can be as ridiculous as this: if a doctor has multiple offices, one location might be covered, the other not. Go to the wrong place, for the same doctor, and you’re out of luck.

Exclusionary Practices for LGBTQ People

People who are gay, lesbian, trans, and as well as other members of minority gender and orientation communities often have a hard time getting fair treatment from insurance companies. For example, it can be very difficult for lesbian couples to get infertility treatment because insurance companies require proof that they have tried to conceive in traditional ways. They won’t simply accept the medical diagnosis if the person cannot, or has no wish to, attempt to conceive through traditional intercourse.

Refusing to Pay for Medically Necessary Care

Yup, this one’s the kicker. There are so many stories of insurance companies denying coverage of medically necessary treatment. For example, the good Samaritan who received third degree burns trying to save a teenaged girl from a car crash. He was half way through the driver’s side window when it erupted in flames, and so did he. He had to hire a lawyer and contact the media before his insurance company would cover any part of his burn ward stay and treatment.

Insurance companies do this because they can. They bet that while you’re dealing with crippling medical conditions and crippling medical debt, you won’t have the resources or the will to demand they provide you with the coverage you pay for.

The running theme here is never take anything an insurance company says at face value. If they deny you coverage, it might be simply because they figure they can. If you can make a fuss, be a squeaky wheel, a thorn in the side, then do it.