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Picking New Insurance Plan?

My practice is inundated at this time of year with calls from patients trying to pick new insurance plans but who are buried under all the little insurance ‘buzzwords’ that describe the various plans and the services they do and don’t offer. Everyone has trouble keeping these straight – because they’re designed that way! It’s always much easier to confuse someone with an unfamiliar use of a common word than to show them entirely new terms. The concept behind having insurance is not about saving money on your everyday healthcare, it’s to mitigate the cost and impact on your family and the rest of your life from a single disastrous event or the gradual evolution and complications of a lifelong medical condition. It’s not an investment, it’s a necessary expense to protect your savings and try to ensure your ability to maintain as much functional capacity in the face of advancing age and disease as possible. The majority of people would spend far less on their healthcare every year and get a far better product in the process if they paid cash from one visit to the next than they do paying annual premiums for health insurance. When you sign a contract with your insurance company you’re really paying them to: (1) negotiate rates with any doctors, hospitals, and other healthcare providers you might use; (2) pay them in the even that you ever need them; (3) eventually take responsibility for the entire bill should the day ever come that it gets so high it’s ridiculous; and (4) make enough extra that they stay in business while you’re in contract with them. The premiums get higher every year for a reason! I’ve created a little Glossary of Insurance Terms to help you wade through all the words as you try to figure out which insurance plan is best for you. I was never very good at these myself, there’s no courses or even classes in medical school on this stuff, this we have to figure out on the fly. I combined about 8-10 different lists, tried to express the definitions in ways that made sense and were useful, and added my own experience where I thought it was helpful. You can visit the Glossary HERE or clicking the image below.

In a few days I’m going to add another Glossary of the different types of insurances that are available and then finally a third about how to read an Explanation of Benefits, and EOB, those envelopes of confetti we get in the mail from our insurance company every time we visit a doctor. Less than 1% of the text on all those pages is meaningful or personal and I think they intentionally write it confuse, enrage, and frustrate – and make your doctor look terrible! If you had asked me prior to doing the research that I did for this piece I would’ve said the carriers make their money on the most expensive plans that cost the most every year, today I’m not so sure. The less expensive plans have proportionately higher deductibles, copays, coinsurances, and cover a fraction of what the more expensive plans do – and I’ll bet there’s a lot more patients buying the plans with the lower premiums than there are paying for the big expensive plans. They get paid somewhat less every month but they offer less, the patients pick-up a lot more of the costs themselves, and they sell a lot more of those plans than they do the expensive ones. If you have any questions don’t hesitate to write or call the office, ask for Anna, she’s our resident Pro at all this! We’re OPEN Saturdays now from 8:00AM to 1:00PM Annual Physicals, COVID-19 & COVID-19 Antibody Testing, Labs, & Regular Visits When shopping for health insurance, you’ll generally face a trade-off between high coverage and low cost. Consider what you and/or your family might need then closely look at each plan option for where the costs are going to occur. Inexpensive plans can be a good deal in a healthy year but an expensive choice if you start to have any issues and subsequent medical expenses. The plans that have the lowest deductibles and the most provider flexibility generally come with higher premiums. The big monthly premiums are scary but if you’re actually going to be using your plan on a regular basis – older with chronic health issues, many kids playing multiple sports, considerable need for speech or PT – you might be much better off than paying less every month and then getting buried with cost-sharing at the office or when the bills start to come in. A few things that occurred to me while I was writing this:

  • ALWAYS BEWARE & BE READY! Your carrier is running a business and it’s on you to be alert to the details of your plan.

  • READ & ASK QUESTIONS UP-FRONT!! Then ask for the answers in writing!

  • If you know you’re going to need one particular treatment or category of treatments CALL & CONFIRM BEFORE YOU BUY!!!!

BEWARE: Multiple individual items within a given doctor’s visit may have their own specific copay or coinsurance: a Radiology copay, an additional amount that you are responsible for any imaging done during the course of your visit; a Diagnostic copay, an additional amount that you are responsible for any testing such as for strep or mononucleosis or of your urine done during the course of your visit; in each instance you are responsible for these at the time of service. BEWARE: You also have to check into whether there are multiple deductibles. In addition to your deductible for physician visits look for separate and additional deductibles within different specialties. TIP: Make some assumptions and then do direct calculations of your annual costs when comparing plans before purchasing, the cost-sharing with the Exchange Plans are designed to discourage use not assist with paying for care and your overall annualized costs over the course of an entire year could be incredibly high as a result and you might be better of with the commercial plan.

  • Don’t accept a gate keeper – get a genuine doctor genuinely wants to take care of patients as opposed to their charts and their pensions.

  • Preauthorization isn’t a promise your health insurance or plan will cover the cost.

  • Preferred providers are OK, but check that they’re not ‘tiered’ and some cost more than others

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