Is Health Insurance Meant To Be Gambling?

I am going through getting new insurance through work, and there are options, but I have had a heck of a time finding out if certain things are covered and I got burned badly last year by the choice that our third party coordinator said covered everything who then decided to refuse to cover certain in-network providers because they were "outside the service area". When I asked the insurance company what the service area actually consisted of, they refused to tell me. We went in circles going through plan documentation that I was not shown before signing up with them which does mention a service area but it is a loop – every reference/footnote just goes to another one that then goes back to the original. Literally none say what the service area is, though ultimately we guessed it probably meant "inside your state of residence", which isn't great if the nearest major city is over the border.

So now I am going with a different company because I am very dissatisfied with how things worked out this year, but I can't get a straight answer out of anyone as to whether or not certain things are covered and whether or not I will face the same problem with something being 'in-network' and then them refusing to cover it anyway. Every call for information results in being told I need to talk to another department who then tells me I need to talk to the first department who then tells me they think it's probably fine but can't be 100% sure until I sign up and pay them a premium.

See also  SPOTLIGHT: NHI IN FOCUS (PART TWO): Where are we in the National Health Insurance legislative process and what happens next? - Daily Maverick

So I have to buy insurance just to find out if insurance covers things? It feels like a scam every single time I touch this stuff, but I wonder if I'm getting unlucky with bad customer service or there's "this one trick" I'm missing.

submitted by /u/JMW007