As I sit in my home office trying to do my part to “flatten the curve,” I’ve found myself fielding more and more service calls for two types of people- those without any health insurance, and those with insurance, but unaware of how it truly works with regards to making a claim.
Although this might sounds unbelievable to many, it’s actually extremely common in today’s confusing health insurance marketplace. That being said, to help shine a light on a possibly confusing topic for many of you, I wanted to take this opportunity and write on how exactly this crazy thing we pay SO MUCH for (health insurance) actually works.
First of all, you NEED to have Health Insurance. Let me say that again- YOU NEED HEALTH INSURANCE. I don’t care that it’s not required by law, I don’t care if you find yourself in the “but I never get hurt or sick” or “this should be provided by the government so I’m going to make my stance by choosing not to pay for it” category, you actually DO need health insurance. Here’s why…
Yes, for your minor sinus infections, UTI’s, stitches, etc., you probably can get away with not having health insurance. A $500 bill likely won’t break you. But what happens if it’s bigger than that- a broken bone that requires surgery, coming down with the flu that turns into pneumonia that requires hospitalization, a cancer diagnosis (also most cancers are NOT genetically transmitted so don’t even go there), a car accident, and the list goes on…
And then there’s the biggest reason for this blog- what if you’re diagnosed with COVID-19 and you’re uninsured? Check out the following link to see what one uninsured’s experience was (if you want to skip the article, the total bill to her was just shy of $35,000): Time.com Article
If you currently don’t have health insurance, please speak to us or someone else you trust about your options.
Now, let’s say you find yourself in that 2nd category- those with insurance, but not sure exactly how it will work at the time of claim. I am happy to help! First off, you have to understand that most policies come with 3 key items that are critical to understanding: a Deductible, Coinsurance, and a Maximum Out Of Pocket. The deductible needs to be hit before the coinsurance kicks in, and once the coinsurance satisfies the max out of pocket, the health insurance normally takes care of the rest of the tab.
For example, let’s say you have a $5,000 deductible, 50% coinsurance, and a $10,000 maximum out of pocket. First off, a $5,000 deductible means that you are responsible for 100% of the bill until you reach $5,000. After you hit $5,000 in bills, coinsurance will kick in and cover 50% of all bills up until you reach $10,000 (max out of pocket), which is when health insurance should cover 100% of the bill. So, depending on the severity of the COVID-19 treatment, with insurance like this and an experience referred to in the above article, a $35,000 bill will still end up costing you $10,000. Yes, the COVID-19 TESTS are covered completely by most health insurance policies, but what if you’re actually diagnosed positive- most want to be prepared.
Now if you’re insured and you don’t have a spare $10,000 laying around (which most don’t), you’ll want to tie a supplemental policy into the coverage that will help you cover that cost. If you took out health insurance through me, you likely know all about this as I see this as an ESSENTIAL part of any health insurance package. If you currently don’t have a supplement, please reach out to me and I will run through it with you. Yes, it will increase the cost, however, I promise it will be affordable and I promise you will be happy you did it.
This won’t last forever, but while we’re all at risk please do yourself and your family a favor and BE PROACTIVE. If you find yourself in one of the two mentioned categories, give us a shout– we’d be happy to help you navigate through it.