I have been a health insurance broker for over a decade. Every day, I read more and more “horror” stories posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses, and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you, the consumer, will suffer. However,
Most people fail to realize that there are very few “loopholes” in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policyholders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallets and place their policy in a drawer or filing cabinet during their 10-day free look. It usually isn’t until they receive a “denial” letter from the insurance company that they take their policy out to really read through it.
Most people who buy their own health insurance rely heavily on the insurance agent selling the policy to explain the plan’s coverage and benefits. This being the case, many individuals who purchase their own health insurance plan can tell you very little about their plan, other than what they pay in premiums and how much they have to pay to satisfy their deductible. For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Purchasing a health insurance policy is not like buying a car.
The buyer knows that the engine and transmission are standard and that power windows are optional. A health insurance plan is much more ambiguous. It is often tough for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policyholders don’t realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that “benefits were denied.
Sure, we all complain about insurance companies, but we do know that they serve a “necessary evil.” And, even though purchasing health insurance may be a frustrating, daunting, and time-consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price. Dealing with small business owners and the self-employed market, I have realized that it is tough for people to distinguish between the type of health insurance coverage they “want” and the benefits they really “need.
Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no coinsurance) and, although I agree that those types of plans have a great “curb appeal,” I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is a 100% health insurance plan something that most consumers really need?
Probably not! In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Just like you would do if you were purchasing options for a new car, you have to weigh all these variables before you spend your money. If you are healthy, take no medications and rarely go to the doctor, do you really need a 100% plan with a $5 co-payment for prescription drugs if it costs you 300 dollars more a month?
Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic Rx co-pay versus an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10generic co-pay after you pay a once a year $100 Rx deductible? Wouldn’t the 80/20 plan still offer you adequate coverage? Don’t you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn’t it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?
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