Tag: insurance

I’ve spent 50 years in business. I have a BBA and an MBA. I’ve read contracts, financial statements, purchase agreements and enough fine print to permanently damage my eyesight.

Then somebody handed me a health insurance policy.

I didn’t understand a damn thing.

Apparently, the health insurance industry decided healthcare wasn’t complicated enough. So they invented their own language.

Office Visit

I’ve visited friends.

I’ve visited relatives.

I’ve even visited France.

Doctor Office visit? 

Thanks for visiting. That’ll be $175.”

Deductible

Now there’s a word I recognized.

I’ve been doing tax returns for 50 years.

Mortgage interest? Deductible.

Business expenses? Deductible.

Charitable contributions? Maybe deductible.

So when my health insurance company said I had a $2,500 deductible, I thought:

Great. Where do I put it on my tax return?

Apparently, that’s not what deductible means.

I got audited

It means I pay the first $2,500.

Why didn’t they just say that?

Co-Pay

This one sounded encouraging.

“Co” means we’re doing this together.

Like co-worker. Co-pilot. Co-owner.

So who’s my co-payer?

Apparently, me.

I go to the doctor and pay $40.

Specialist? $75.

Urgent care? $100.

Emergency room?

At this point, I think we should eliminate the confusion and rename it:

I-Pay.

Coinsurance

Wait I already bought insurance.

Now I need insurance for my insurance?

Not exactly.

Coinsurance means that even after I pay my deductible, I may still pay a percentage of the bill.

The insurance company might pay 80%.

I pay 20%.

So I pay a premium so I can have insurance.

Then I pay the deductible so I can use the insurance.

Then I pay coinsurance after I’ve used the insurance.

Networks 

In-Network

This means your doctor has an agreement with your insurance company.

Good.

Out-of-network means your doctor doesn’t.

Not so good.

The problem is figuring out who’s in which network.

Your doctor may be in-network.

The hospital may be in-network.

The anesthesiologist who appears for 11 minutes while you’re unconscious?

Good luck.

Prior Authorization

Here’s another beauty.

Your doctor examines you and decides you need a test.

But before you can have it, the insurance company may want to decide whether you need it too.

Apparently, medical school is no longer enough.

You also need permission from someone you’ve never met.

Explanation of Benefits

After all this, the insurance company sends you an EOB — Explanation of Benefits.

Across the top, in large letters, it says:

THIS IS NOT A BILL.

Then it contains:

Amount billed: $4,850

Allowed amount: $2,375

Plan paid: $1,420

Your responsibility: $955

Naturally, you spend the next 20 minutes trying to figure out:

If this isn’t a bill, why are you telling me I owe $955?

Now Compare the Plans

This is where health insurance reaches its full potential.

Plan A has a lower deductible but a higher premium.

Plan B has a lower premium but higher coinsurance.

Plan C has better prescription coverage but your doctor isn’t in the network.

Plan D has a $7,500 out-of-pocket maximum, unless something doesn’t count toward the out-of-pocket maximum.

So you finally ask the insurance agent the only question that matters:

“Which plan gives me the best coverage at the lowest price? 

And the answer is basically:

“How sick are you planning to be next year?”

That’s the problem.

You’re choosing insurance today based on diseases, accidents, prescriptions, specialists, MRIs and emergency-room visits that haven’t happened yet.

What the Hellth! 

You can’t make this stuff up.