Buyer: Beware of Low Cost Health Care Insurance

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HEALTH CARE $75 PER MO/FAMILY COVERAGE…You’ve seen the hand made signs posted on telephone poles at high traffic intersections. What a great deal, right? Especially for the average joe with a family of four who goes without insurance because he cannot afford to have $300 deducted from his bi-weekly pay check. Instead he and his wife put off their yearly physicals and hold their breath when they get an incoming call from the kids’ school, praying no one has gotten hurt.

Did you know that a recent Harvard University study showed that half of the bankruptcies were a direct result of catastrophic medical bills? In a world of uncertainty, insurance brokers prey upon families with lures of low cost health insurance. They dangle this false sense of security like a carrot and unfortunately the unsuspecting bite down hard. It is not that they don’t provide the coverage but somewhere in the fine small print the bottom line gets lost.

Allow me to tell you what $75 a month buys you. For example, a well woman’s exam generally includes a Pap smear, breast exam, glucose check, blood pressure check, and urinalysis, the total cost is around $450. Your wonderful discount plan reduces your bill anywhere from $20-$50 dollars. Guess who is responsible for the rest?

I have worked in medical insurance billing for twenty years and I cannot count the number of times I have had to do what insurance brokers should have done prior to making selling a medical policy. I call it the “OH?” factor. This is the response I get when I advise a patient that her policy only covers $50 dollars on a routine pap, or if she seeks any medical care before the six month waiting period is up, she is liable.

I don’t mind explaining a patient’s policy; in fact it is my job to inform them what they are being billed for. On the flip side, I am compelled to help try to prevent them from being put in the position in the first place. Here are a few helpful hints when seeking health care coverage.

(1) Is there a waiting period or pre-existing clause in my policy? (Pre-existing clause stating if you have any healthcare condition that they think you had before you bought the policy they are not responsible to pay?

(2) Do I have routine coverage? (You would not believe the number of people who are sold medical policies without the basic routine coverage.)

(3) Am I responsible for a percentage of a bill or flat co payment? (Typically, $15, $20, or $30 per office visit)

(4) Are labs, x-rays, or special testing covered in my policy? (Is it really feasible to have a policy that does not cover the most expensive things?)

(5) Do I have a maximum cap on my policy? (This little word can have big consequences, know exactly how much the insurance company is required to cover)

Ultimately, it is the patient’s responsibility to do the research and know what their plan entails, but if you don’t know French you can’t speak the language right? If you are uninsured, and seeking coverage please proceed with caution when dealing with insurance brokerages. Educating yourself saves you time and money and also helps prevent costly mistakes that could jeopardize your family and your future.