Wednesday, May 18, 2011

Paying For Doctors You Don't See

Have you ever heard the phrase “You get what you pay for”? Well what about paying for something you don’t get? Many people are in just that situation when it comes to their health insurance.

I found that by examining my policy closely that I was paying for doctors that I never saw and you may be too.

Everything has a cost. When you buy a car and add the GPS there is a cost. Add the leather interior and the cruise control and you wind up paying extra. Why should we think that health insurance is any different?

Everything in life has a cost associated with it. Actuaries in the insurance industry make their living by evaluating the revenue that an insurance company takes in and comparing it to the claims that it historically pays out and they price plans accordingly. That means that every part of your policy has a cost associated with it; Doctor visits, prescriptions, lab exams, ER visits, surgeries and hospitalization costs can all be charted and as a result they can be priced accordingly.

I recently reviewed my personal plan and realized that $142 of my monthly premium was providing me with a co pay when I went to the doctor even though I rarely go more than one time a year. That adds up to over $1700 a year so that I would have a co pay of $30 dollars when I actually saw a doctor. Does that make sense?

Granted I’m not a 35 year old male, but even if it means that $30 or $40 a month of my premium simply provides a co pay I may still be wasting money most of the time.
And, in a year where I do encounter medical issues if I am covered correctly once I meet my deductible my medical costs are covered including follow up doctor visits.

Let’s take a step back and look at the larger picture. Most of us don’t go to the doctor on a regular basis. Sure there are the colds, flu’s, minor aches and pains, checkups, (now covered by Obama Care), and minor cuts and scrapes. But, what do we really have insurance for in the first place? I call insurance protection for the “what ifs”. Things like heart attack, stroke, cancer, diabetes, etc.

We all have life insurance in case we die. We worry about serious illness or accidents, disability and long term care, but was insurance really ever designed to cover every cost that we as humans can encounter? ; Of course not.

My point is simply this, we are all different and we all have different needs, but we all need to evaluate the way we structure our healthcare the same way we evaluate our auto and homeowners insurance to insure that we are purchasing the proper level of coverage that meets our unique insurance needs.

But you still have to be careful. For instance I meet people everyday who make the mistake of not accepting prescription coverage simply because they are not taking medications today. This can put them at risk for expensive prescriptions or even chemotherapy treatments that are many times considered prescriptions later in life and then it’s too late.

An agent that works for one insurance company or a telemarketer that represents an online site needs to sell you a product, their product. That’s why you need an independent broker that has the flexibility and the knowledge to present a wide range of options that best meet your unique needs so that you make an intelligent decision that provides you with the best coverage at the best price.

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