Ask Colleen King

Health insurance thoughts are usually more focused on what doesn’t work instead of people being grateful that they have it. Not all plans are good, but most are. The actual cost of care would wipe most people out if something significant happened to their health.

But if you purchase your own coverage or you obtain it through your job, be happy you have it. Even with the higher deductible plans, if you have a couple of minor health issues during the year and you are paying for the care, you benefit from it. I met with a client this week who is moving out of the country and we were assessing what she might need to do for coverage.

She asked me what good her coverage had done for her the past few years since she was paying for everything. We dug out some of her explanation of benefits (EOBs) she had gotten from the carrier. We went over a few and it made sense. Fortunately she hadn’t needed a lot, but the benefit could be seen. One column shows the ‘billed charges’ which is the amount the doctor submitted. The next column showed the ‘allowable amount’ which is what the contracted rate was the doctor had with the carrier, or the discounted amount. The next two columns showed the amount paid by the carrier which was zero, and the amount she owed.

The benefit in this scenario was the discounted rate for the services. When selecting a care provider it is always in your best interest to see someone contracted with your insurance carrier in order to pay a discounted rate. Once you hit your deductible on a PPO plan, if you see providers not contracted with your health plan the reimbursement will be at a lower rate than a contracted provider. So you still get some help with costs. This doesn’t apply to HMO plans, as only emergency care is covered.

So coverage for bigger problems, discounted rates, these things help with your costs when seeking care. Compare your health insurance to your homeowners or auto policies. People usually try not to submit claims to either of these types of coverage out of fear that their rates will go up, or they will be cancelled. Your health insurance cannot go up because of YOUR claims specifically. Nor can it be cancelled because of claims, whereas your homeowners insurance can. Something to think about……….Be Well this holiday season!

Tags:   Group Health Insurance · Health insurance · Individual Health InsuranceNo Comments