Questions to ask your insurance agent. These questions will help to
ensure that your agent is being honest with you and help you
understand and some of the big differences in the different types of
policies.
1. Stop Loss- (The maximum out of pocket you will pay before you
have 100% coverage for the rest of the year.) Most companies it will
be under $5,000. There is a couple of companies that don't actually
offer a Stop Loss. They will have limits to what the company will
pay out but they have no limit to what YOU will pay out. This is the
most important aspect to your insurance policy. I have seen some
people get stuck badly with $50,000-$200,000 worth of medical
expenses without a good stop loss.
Question to ask your agent: What is my maximum out of pocket (stop
loss) per year before I have 100% coverage?
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2. Deductibles- Some companies will have separate deductibles for
different aspects of their policies.(Testing deductible, therapy
deductible, chemotherapy coverage, separate accident deductibles
etc.) This is where some insurance companies depend on there being
big holes so that they don't have to cover things that may otherwise
be covered. Ex: Things that one company may call testing and
therapy, may not be considered the same type of procedure by another
company. If something falls between categories for different
deductibles, you will be stuck paying bill for all of it. You want a
plan that has ONE DEDUCTIBLE. This way there are no gaps. You reach
your one deductible each year, then everything that is covered under
your policy will be covered as your policy states. It drastically
eliminates holes in your policy.
Question to ask your agent: How many deductibles does my policy
have?
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3. Networks- You want to be in a plan that offers networks. Some
companies will offer plans that are good at any doctor, any
hospital, anywhere in the country. This is a great selling point but
unfortunately, it is also very dangerous. Networks exist for very
good reasons. If you have a plan that has big coverage holes in it
and you go to a doctor for some reason, anything that is not covered
by your policy you will pay 100% of all costs and you will pay 100%
full retail price for it. If your plan has holes in it this can be
catastrophic financially. Insurance companies and doctors give their
customers/patients what is called 'Network Pricing". If you go to a
network provider with insurance and something is not covered by your
plan, in many cases you will still get the big discount that the
insurance company would get just because you have insurance. This is
"Network Pricing". Some companies offer nation wide networks so even
if you travel a lot you will never be out of network. This is very
important.
Question to ask your agent: If my company doesn't use networks
and I have medical procedures performed that are not covered by my
policy, how much will I have to pay? Do I get a discount because I
have insurance? (The correct answer to this is you will have to
pay 100% of retail prices. If the company does not use networks, any
other answer is either wrong or deceptive.)
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4. Coverage per period of confinement- Some companies will have
definitions for deductibles as "per period of confinement." Ex: Your
plan could have a $1500 deductible but we need to know if it is a
yearly deductible or "per period of confinement" deductible. Some
companies will list a period of confinement as 90 days. This would
mean that if you are hospitalized for the same thing within 90 days
you only have to meet one deductible. However, if 91 days later you
have another medical problem, you will then have to hit ANOTHER
$1500 deductible.
Again, this is another scary scenario.
by: Shad Woodman
