Tuesday, January 22, 2008

Mindless Insurance

Need medical care? No problem. You have insurance. They will pay your bills.

How much does it cost?

You have no idea. The insurance company will pay the bill.

Or will it?

On Aug. 17, my 14-year-old son was kicked in the groin during a preseason soccer match. . . The urologist at our community hospital suggested an ultrasound to make sure there was no internal damage. Since it was late on a Friday afternoon, the doctor recommended that my son go to the hospital's emergency room for the scan. The results, fortunately, were benign and my son recovered quickly.

But a month later, the bills started flooding in: hundreds of dollars from the hospital ER, plus a few hundred more from several ER doctors and the urologist who treated my son. We also owed hundreds more for other medical services my family and I had used. On top of that, we still were obligated to pay hundreds to the orthodontist for my son's braces and several hundred dollars to podiatrists for services not covered by our plan.

By last fall, we owed nearly $3,000 in medical expenses.

ER, ultrasound, braces, podiatrist . . .

Sounds like $3,000 out of pocket is a bargain.

Especially for services that are not covered . . .

The bills had begun accumulating shortly after my husband, a social worker, switched jobs and we were forced to change health insurance from a local Blue Cross plan to a for-profit national plan. My husband was not offered a choice of health plans, and when we signed up it was not made clear that our deductible for the year would be $3,000 (for in-network expenses; $4,500 for out-of-network expenses).

Not made clear.

Was the policy written in Chinese?

Nor did we understand that once we met the deductible (i.e., spent $3,000 to $4,500 of our own money), we would then have to pay co-insurance: 15 percent of every in-network expense we incurred and 45 percent of any out-of-network expenses.

Is English their primary language?

Does anyone bother to read their policy, or do they just sign up for Mindless Insurance and assume anything they want is covered?
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