Ask the Chiro: Do I Have Good Insurance

With health care being one of the most important topics of the 2016, people are clearly concerned with where health care is going and how it affects them. Ironically, however, one of the most common trends I have notices in 2016 is that few individuals actually know what their health care coverage is. The most common phrase that I have learned to shrug off and give little attention to this last year has been “My insurance is really good.” Although it feels good to say you have good insurance, a look at the actual plan usually reveals that in reality, you have very typical insurance, which in today’s health care, is not very good at all. This person is soon surprised to hear that not only is their insurance not as good as they thought, but they will be paying for more out of pocket than they expected as well. Having said that, there are good insurance plans out there, and that my position is only in respect to chiropractic care and not all health care. However, as I have noted in previous articles, your health care is your responsibility, which means in order to maximize your dollars, you should know the details of your insurance. This will allow you to understand what is and isn’t covered, how much is covered, and how much you should budget to cover your known health care expenditures. So to start out, here are a few details about your health insurance you should know.


1) Premiums

A premium is like a payment on a car. It is the fixed cost (typically monthly) that is paid to actually own insurance. This is probably the most familiar term to consumers because its the term they directly pay to the insurance company. Premiums are the primary means by which your insurance company makes money. This also means the more you pay to the insurance company, the more they are willing to give back in terms of coverage. This may be a good or a bad thing, depending on your state of health, but thats for another discussion. There big takeaway with premiums as they relate to your health care costs, is that it is a fixed cost. This means it will be paid regardless of how little or how much you actually use your insurance. So if your premium is one thousand dollars a month, your fixed cost for the year regardless of how much you use the insurance is already up to $12,000.


2) Deductibles

The deductible is one of the most variable characteristics of a health care plan. This is the amount of money that must be spent by the consumer before an insurance plan begins to cover for services.  So taking the $1000 monthly premium from before, if that plan also has a $3000 dollar deductible, then your known cost for health care will reach $15000 for the year to receive any benefits from your plan. Minimizing health care costs used to be as simple as finding the smallest deductible plan you could in order to limit out of pocket costs. However, with the onset of larger co-pays and co-insurance and substantial increases in premiums, some may actually benefit from having a larger deductible if properly matched with some of these other variables.


The biggest note to be made about the deductible is that although it is a set amount that you must pay before your insurance plan begins to cover services, it is still a theoretical amount. That means that if you are completely healthy throughout the year and only go to the doctor once, you will probably not pay the full deductible that year. So if an individual is actually quite healthy, and does not have a large amount of visits, medications, or procedures that he or she anticipates for the year, choosing a plan with a higher deductible plan may actually be cheaper. Higher deductible plans typically have a lower premium, which will decrease an individual’s fixed insurance costs. Therefor, reducing the definitive costs of a premium by enlarging a deductible you are not going to meet anyways is a cheaper option for a healthy individual.


3) Visit Limits

This is a big subject for those who see chiropractors, physical therapists, or any other rehabilitative, manual, or alternative medicine health care professionals. MANY  insurances lump these providers into one group (specifically physical therapists and chiropractors) and apply an “allowed visit” amount to them. Typically this is around 30 visits and sets a guideline to how many visits for this type of care that insurance will pay for.

In an individual who happens to be in great health this may not be an issue, but there are few that meet this criteria, and often, many need more visits. Many times we will get a patient that has received previous care before presenting to our office, and often are only left with a few covered visits for the year.  Another situation that comes into play with visit limits is that sometimes, insurance never ends up actually paying the bill. How is this possible? I thought the allowed visits was to outline the number of visits insurance would pay for? Well, remember our Debbie Downer deductible? If you are an individual who has a large deductible or are very healthy, your deductible may render your visit limit pointless. This is because this visit limit counts on each visit even if you are footing the bill. For a lot of people, this means they blow straight through their 30 visits without even coming close to meeting their deductible. Now it is possible to lobby for more visits, but in this scenario, you are often at the mercy of an insurance company being the one who approves whether or not they pay for more visits.

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