Policy-Pitfalls-Power Plays Podcast

Why Do Health Insurance Companies Deny So Many Claims

In this episode, Eric Buchanan and John Ballinger uncover why health insurance companies deny claims so often, even when people believe they have solid coverage. They explain how contract language, medical necessity standards, and internal cost containment policies are used by insurers to avoid paying. The hosts also discuss the role of third party administrators, utilization review, and appeal procedures that are often stacked against consumers. Listeners will learn what steps they can take to challenge health insurance denials, how to preserve their rights during the claim and appeal process, and why persistence can pay off.

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 discuss the wide variation in insurance regulations from one state to another and how weak enforcement and insurer friendly rules often leave policyholders with few protections. The hosts also explore why insurance lobby groups push for laws that limit policyholder remedies, including caps on damages and restrictions on consumer lawsuits. Listeners will gain a better understanding of how their state laws impact their rights and what they can do to be better prepared before a claim ever happens.

Insurance Subsidies, Deductibles, Out of Pocket Costs, Copays, Coinsurance, Specialty Visits, and Prescription Costs

In this episode, Eric Buchanan and John Ballinger break down how insurance actually works in real life when it comes to costs. They explain insurance subsidies, deductibles, copays, coinsurance, and out of pocket maximums in a clear and practical way. The hosts walk through common sources of confusion such as tiered prescription pricing, specialty drug costs, and what happens when a provider is out of network. This episode is designed to help listeners understand the true cost of their insurance plan and how to make smarter choices when managing medical bills and coverage options.

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.

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.

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 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.

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.

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.

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.

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.