Money Matters: Health insurance is like buying a fire extinguisher that only works on Tuesdays, unless the fire is red, in which case you need prior authorization.

And if you actually use it? Surprise - it’s not covered, but thanks for paying your premiums!

The companies make it sound like they’re protecting you, but really they’re protecting their bottom line. The plan’s not a net - it’s a web, and once you’re in it, good luck getting free.

Today I’m breaking down seven ways they squeeze you, so you can finally push back and keep a little more of your own money.

Survey says: The average U.S. family pays $7,739 per year in premiums — before deductibles or co-pays.

Roughly 18% of all medical claims get denied on the first pass. Most people don’t appeal - but 60% of appeals succeed.

One in five Americans has medical debt on their credit report. Insurance didn’t prevent it - sometimes it caused it.

Administrative costs eat up 15–20% of U.S. health spending. That’s billions spent telling you why you don’t qualify for coverage.

Here is what on that portioned plate today:

😎 Our Favorite Resources
👍 The Playbook Your Health Insurer Hopes You Never See
👌 The Insurance Phone Call Survival Kit
🤷‍♀️ What’s up for next week

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Cool Links

Our favorite resources

💵Budgeting

• GoodRx – Discounts that often beat “covered” prescription costs.

• Healthcare Bluebook – Compare fair prices for procedures in your area.

🏥 Health Links

• How to appeal a health insurance claim denial – Straightforward guide for when your insurer says “not medically necessary.”

• Patient Advocate Foundation – Free case managers who help you fight insurers.

• KFF Health Insurance Basics – A breakdown in English, not legalese.

• Fair Health Consumer – Find what insurance “usual & customary” should really mean.

👀ICYMI

9 Ways to Lower Your Housing Costs Without Moving - nine practical, money-saving strategies that cut your biggest monthly bill without the hassle of packing boxes.

📜Quote

“If a 6 foot tall talking Badger comes to your door with a great deal on health insurance, be certain to ask if it includes in-patient psychiatric care.” - David C Holley

Today’s Main Event

The Playbook Your Health Insurer Hopes You Never See

Health insurance isn’t broken — it’s a funhouse mirror.

You walk in thinking you bought protection, and you walk out $500 lighter with a consolation prize of store-brand aspirin with an expiration date from the 1980s.

Read on, because these seven insider hacks are the hammer you’ll need to smash the mirrors.

1. The “Not Medically Necessary” Scam

Doctors say you need it. Your body says you need it. Insurance says: Nah. 

Why?

Because if they stamp it “not medically necessary,” they pocket the cash.

What to do: Always appeal. Half the time, insurers back down the moment you challenge their medical “judgment.”

2. Deductibles - The Phantom Coverage Trick

Your deductible is their favorite illusion: you think you’re “covered,” but in reality, you’re fronting thousands before they spend a dime.

It’s not insurance — it’s a loan shark in a white coat.

What to do: Ask your insurer for a year-by-year breakdown of how much you’ve paid before they’ve paid anything. That data becomes ammo if you challenge unreasonable hikes with your state insurance commissioner.

3. The Premium Creep Boil

Your premiums rise like your in-laws’ expectations: slowly, then all at once. A 5% increase here, an 8% bump there - until you’re paying more than your mortgage.

Insurers bank on the fact you’ll groan but not switch.

What to do: Shop your plan every open enrollment. Loyalty gets you nothing but smaller portions at bigger prices.

4. The Network Trap

“Oh, that doctor was out of network? That’ll be $2,000.”

Networks are the health insurance version of a nightclub velvet rope. The bouncer is your insurer, and you’ll pay triple if you wander into the wrong room.

What to do: Always ask: “Is everyone involved in my care in-network?” That includes labs, anesthesiologists, and the guy who wheels you into the MRI machine.

5. Surprise Billing: The Jump Scare

You went to an in-network hospital. Great. But the ER doc wasn’t. Surprise! You just unlocked the $6,000 “out-of-network boss fight.”

What to do: Thanks to the No Surprises Act (2022), you can fight these bills. Demand they be processed as in-network.

6. Pharmacy Pricing Shell Game

Here’s a fun one: sometimes paying without insurance is cheaper than using it. Why? Because your insurer “negotiated” a price higher than what GoodRx offers in 30 seconds.

What to do: Always check cash prices before handing over your insurance card.

7. The Pre-Approval Circus

Pre-authorizations aren’t about safety. They’re about stalling. The longer they delay, the fewer claims they pay this quarter. They hope you’ll give up.

What to do: Fight back! Have your doctor’s office handle the paperwork, and if denied, appeal immediately. Persistence here saves thousands.

The Insurance Phone Call Survival Kit

Calling your health insurer shouldn’t feel like auditioning for a hostage-negotiator job, but here we are.

Lucky for you, we’ve assembled these word-for-word scripts so you don’t need a law degree - or a bottle of bourbon - to win.

1. The Denial Appeal Opener

“I’ve received your denial letter. My physician has confirmed this treatment is medically necessary.

Please advise me on the fastest way to file a formal appeal, or I’ll need to escalate this to my state insurance commissioner.”

2. The Surprise Bill Blocker

“This bill is for an out-of-network provider I never chose, inside an in-network hospital.

Thanks to the No Surprises Act, you’re required to treat this as in-network.

Can I get that in writing today?”

3. The Premium Negotiator

“I’ve been a customer for years, but these premium hikes are unsustainable.

If we can’t resolve this today, I’ll need to explore other carriers and possibly raise the issue with my state insurance commissioner.

Can you help me avoid that?”

4. The Deductible Detective

“I’d like a clear explanation of what counts toward my deductible.

Could you outline the types of charges and provide an example for clarity?

And if possible, point me to where this is stated in my policy documentation.”

5. The Prescription Price Check

“I’d like clarification: this prescription is available for $40 with GoodRx, but $95 under my plan.

Please explain the reason for this difference and whether there’s a lower-cost option within my coverage.”

6. The Pre-Auth Fast Track

“My doctor has certified this procedure as medically necessary.

If your team denies coverage, please provide the name and credentials of the medical director responsible, along with the clinical criteria used, so I can include them in a regulatory review.”

7. The Escalation Button

“I’m requesting immediate escalation to a supervisor with decision-making authority.

If this request is denied, please provide me with your written policy on escalation procedures so I can reference it in any formal appeal or legal action.”

Pro tip for readers:

Say these scripts calmly, with a smile. 

Insurance reps are trained to handle yelling - they’re not trained for polite persistence backed by facts.

That’s how you win.

Until Next Time

What’s Up Next Week

Health insurance is less about health and more about finance disguised as medicine. Your job isn’t just to survive the illness - it’s to survive the billing system.

One actionable takeaway: never accept the first “no.” 

Whether it’s a denied claim, a surprise bill, or an inflated prescription, the first answer is just their opening offer.

Push back, and suddenly their “rules” become “guidelines.”

Next week: We’re pulling back the curtain on another money secret your wallet will thank you for - you won’t want to miss it!

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DISCLAIMER: None of this is financial advice. This newsletter is strictly educational and is not investment advice or a solicitation to buy or sell any assets or to make any financial decisions. Please be careful and do your own research.