ProPublica and NPR team up to investigate practices within the health insurance industry. Follow one man’s case in an attempt to understand how a claim is paid and try to decode the Explanation of Benefits (EOB).
Michael Frank is more fortunate than most. He has worked in the insurance industry for 30 years and is covered by his employer’s health plan. It wasn’t until he needed a partial hip replacement surgery that he was exposed to the consumer side of the industry.
One month into his recovery the final bill arrives. Rather than pay the bill, Frank questions the decision. He becomes increasingly outraged as he is bounced back and forth between the provider and his insurance company who avoid answering his inquiries.
Frank uncovers a secret system of pre-cut deals that offer little transparency to the consumer. The standoff ends up in court resulting in more questions than answers.
See how the story unfolded in this story by ProPublica and NPR