Thursday, February 07, 2008

To Be Continued . . .

Don't you just hate those cliffhangers? The tension builds to a peak, then just when you think the answer is going to be revealed, the screen freezes and the dreaded words "to be continued" appear.

For many, health insurance is like a cliffhanger.

Is this covered by my copay?

Will this provider's charges be paid in full?

What is a deductible and when do I pay it?

Does coinsurance (whatever that is) apply or is the procedure part of my deductible or copay?

Inquiring minds want to know and usually the answer for many is "to be continued." The answer appears when they get the E.O.B. (explanation of benefits) from their carrier and a subsequent bill from the provider.

For too many, health insurance IS rocket surgery.

"With one policy we had couple years ago it supposedly covered 80 percent of doctor’s visits. When you'd go to the doctor the bill would come broken down into three things: what the visit was, what the nurse did, and what labs went out. It was a $200 to $300 bill for whole thing and the insurance company would say we'll cover $50. You’d call up and say I thought you'd cover 80 percent and they’d say, yeah, but only up to what we think is fair."

To clarify, the carrier was probably reimbursing what is considered "reasonable and customary" which is an average of similar charges for the same procedure in a given geographic area. The patient thought the bill was fair but the reality is the provider was charging more than other providers in that area charge for the same procedure.

In effect, it was the provider who was being unfair.

Doc copays are one of life's mystery's (at least to consumers). If you read your policy you will see that, in most cases, the copay is only good at a par provider and (usually) doest not include any lab work.

Copays are expensive for the carrier and expensive for the consumer.

They also confuse the issues.

The answer is to simplify everything. But most consumers are not ready for health insurance with no moving parts.

Health insurance is the only form of insurance with multiple deductibles, copays, coinsurance.

Compared to auto, homeowners, and life insurance, health insurance can be complicated.

So how do you demystify health insurance?

Buy a plan that is a deductible then 100%. No guess work. No mystery. No cliffhangers.

So, who shot J.R?
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