Policy-Pitfalls-Power Plays Podcast

Rescission – Post Claims Underwriting

This episode explains how insurance companies sometimes try to cancel a policy after a claim is filed. Eric and John discuss rescission, which is when an insurer retroactively cancels a policy by claiming the applicant left out important information. They also cover post-claim underwriting, where insurers review the application only after a claim is submitted and look for mistakes to deny coverage. The episode highlights why these practices are harmful, how they create unexpected issues for policyholders, and what consumers should keep in mind when applying for insurance or filing a claim.

The Ways Insurance Companies Make Money

In this episode, Eric and John walk listeners through the business model of insurance companies and how those companies generate profit. They explain the balance between collecting premiums and paying claims, the role of underwriting, and how insurers use data, actuarial tables, and risk pools to stay profitable. The hosts also discuss investment income, administrative costs, and why insurers sometimes benefit from delaying or denying claims. This episode helps listeners see the incentives behind the decisions insurers make and why understanding those incentives can help you better navigate your own insurance challenges.

Insurance Subsidies, Deductibles, Out of Pocket Costs, Copays, Coinsurance, Specialty Visits, and Prescription Costs (Generics vs Brands)

Eric and John unpack the complicated world of health insurance cost sharing. They explain how subsidies work, what deductibles really mean for consumers, and how copays and coinsurance shift more costs onto patients depending on the type of care they receive. The episode also covers specialty doctor visits, tiered pharmacy pricing, and why generic drugs are often treated very differently than brand name medications. By the end, listeners will have a clearer picture of how their plan works, what expenses they’re responsible for, and how to make smarter decisions to minimize out of pocket costs.

How State Laws Make It Easy for Insurance Companies to Deny Claims

In this episode, Eric Buchanan and John Ballinger explain how insurance companies use state laws to their advantage when denying claims. They walk through how insurance regulations vary from state to state and how weak enforcement or insurer friendly rules often leave policyholders with minimal real protection. They also talk about the power insurance lobbyists have in shaping laws, including imposing damage caps and limiting a consumer’s right to sue. Listeners will understand how their state’s legal framework affects their rights and what they can do to be better prepared before trouble ever arises.

Why Health Insurance Companies Deny So Many Claims

Eric Buchanan and John Ballinger break down why health insurance companies deny claims at such high rates, even when people think they’re fully covered. They dig into how insurers use complicated contract language, narrow definitions of medical necessity, and internal cost containment systems to avoid paying. The hosts also explain how third party administrators and utilization review departments can delay or derail legitimate claims. You’ll learn what steps to take when your claim is denied, how to protect your rights during the appeal process, and why staying organized and persistent can make a difference in getting approved.

Do You Really Have Flood Insurance?

In “Do You Really Have Flood Insurance?”, Eric Buchanan and John Ballinger explore what flood insurance covers, and what people often think it covers but it doesn’t. They dig into the gaps, misunderstandings, and limitations of flood insurance policies, especially under the National Flood Insurance Program (NFIP). The episode aims to help listeners assess whether their flood protection is sufficient, how to check for exclusions or shortfalls, and what steps to take if you find that you thought you had coverage but don’t.

What To Do With A Claim!

In “What to Do with A Claim!”, Eric Buchanan and John Ballinger walk listeners through the steps to take once a claim arises. They explain how to approach the process from the start, including reviewing your policy, documenting everything, communicating effectively with your insurer, and avoiding common mistakes that can weaken your case. The episode highlights the importance of being proactive and organized so you can protect your rights and maximize your chances of a fair outcome when dealing with an insurance company.

Auto Insurance with John Ballinger

In this episode, Eric Buchanan and John Ballinger dive into auto insurance—what it covers, where people most often misstep, and how policy wording, claims, and risk exposure all play out on the road. They talk about typical pitfalls drivers encounter underinsuring, misunderstanding coverage limits, gaps in policy definitions, and what to do to avoid getting stuck if an accident or damage occurs. The hosts also stress the importance of reading your auto policy carefully and knowing what your insurer expects in terms of documentation and timing when making a claim.

Homeowners Beware!

In “Homeowners Beware!”, hosts Eric Buchanan and John Ballinger focus on risks, pitfalls, and important considerations for homeowners when it comes to insurance. They emphasize that many homeowners don’t fully realize what’s in their policies until after something goes wrong. The episode discusses what homeowners should watch out for—hidden exclusions, ambiguous definitions, coverage limitations, and how to read policies carefully. It also offers suggestions on how to avoid surprises in the event of damage, claims, or disputes with the insurer.

The Economics of Why Insurance Deny Claims?

In this episode, Eric Buchanan and John Ballinger dig into the financial and economic incentives behind why insurance companies deny claims. They explore how those incentives shape insurer behavior, what factors influence denials (contract wording, risk calculations, cost containment, etc.), and the downstream effects on policyholders. The hosts also walk through what policyholders can do to anticipate potential denial risks, protect their claims, and push back effectively when a claim is wrongfully denied.

Exclusions and Definitions!

In “Exclusions and Definitions!”, hosts Eric Buchanan and John Ballinger examine how the definitions and exclusions in insurance policies can drastically alter what’s covered. They break down how certain terms and clauses — things like “named perils,” “all risks,” “endorsements,” etc. — can lead to gaps in coverage if you’re not paying attention. The hosts also discuss why insurers tend to rely on exclusions, how policyholders often misunderstand them, and what you should look out for, so you don’t get surprised when filing a claim.

The Claims Process: Do’s and Don’ts

In this episode, Eric Buchanan and John Ballinger walk listeners through how to handle the insurance claims process wisely by highlighting what to do and what to avoid. They discuss common mistakes people make that end up helping insurance companies more than claimants, and they offer practical advice to protect yourself and get the best possible outcome. The hosts also explain how to approach documentation, communication, policy knowledge, and timing so that your claim isn’t unnecessarily delayed or denied.

Intro Episode! Why a Podcast – How Has Insurance Changed – How Does it Affect Us – What Should it Look Like!

In this introductory episode, hosts Eric Buchanan and John Ballinger set the stage for the podcast by explaining why they launched it and what listeners can expect. They discuss how insurance has changed over time, the impact those changes have on individuals and businesses, and what a better insurance system should look like. The episode also touches on practical strategies for navigating the complexities of today’s insurance landscape.