Ins and Outs of Insurance

Health Costs

 

Health insurance is unique.  Compared to other types of insurance out there it gets used much more frequently.  Think about it.  In a good year you won't need to use your flood insurance, car insurance, and heaven forbid… your life insurance.  However, you always have health needs.  There are check-ups, screenings, prescriptions, treatments, procedures and the list goes on.

Health insurance can be pretty complicated to understand sometimes.  Co-pays…. Co-insurance… deductibles… Out of Pocket… It's almost like they are trying to confuse you on purpose.  This post will give you some of the basics about how insurance works, how and when it doesn't work and how to get and stay healthy whether you have it or not.

How Do I Know If Insurance Covers Chiropractic Care?

Most of the time we offer to check people's insurance benefits for them.  This is because we know the right questions to ask as far as which services are covered.  For many insurance companies we can log in directly and view the specifics of your coverage.  Don't rely on what is written on your card with regards to co-pay amounts or Office Visit payments.  That's for when you go to the hospital or to see your MD.  There is a customer service number on your insurance card that you can call and request your Chiropractic Benefits.  Sometimes they will be listed under complementary care.  This will often include Physical Therapy, Acupuncture, and Massage.  For example if there is $2,000 of coverage for complementary care your Chiropractic, Acupuncture and whatever else will draw from that common pool of $2,000.

So What the Heck is a Co-Pay Anyway and Is It The Same As Co-Insurance?

Your health insurance policy is likely set up so that you pay for some of the care out of your pocket and the insurance company pays part as well.  A co-pay is a fixed dollar amount that you pay per visit.  After you pay that amount the insurance will cover a percentage of your care.  Most insurance companies will cover 100% of your care after you pay a co-pay of something from $5-45.  This is nice because your out-of-pocket costs become very predictable.  Co-insurance is when you split a percentage of the total cost of the visit with the insurance company.  For example you may pay 30% of the treatment cost while your insurance company covers the other 70%.  Most insurance contracts require that co-pays or co-insurance are paid when you go in to receive care.

What Is A "Preferred Provider" or "In Network Provider"?

You will typically pay a lower co-pay or co-insurance if you go to a Preferred Provider or somebody who is "In Network" with your insurance company.  This basically means that the doctor has a contract with the insurance company that usually will give the insurance carrier a discount on services provided to people with their insurance plans.  The amount a doctor will need to write off varies from insurance company to insurance company.  Your insurance may provide "Out of Network" coverage but you may end up paying a higher co-pay or co-insurance.

What Is A Deductible?

Your deductible is the amount you need to pay for health services before the insurance will start to pay anything.  Some policies don't have deductibles.  Some are small like $200-500.  Others are large like $1,000+.  Your deductible will reset each year.  Some plans reset on the calendar year meaning that in January you will have to start over and pay your deductible again.  Other plans will reset one year from when the plan started (June to June for example).  Most insurance contracts between the company and the doctor prevent the doctor from waiving any deductible fees.

What about an HSA or FSA?

HSA stands for Health Savings Account and FSA is a Flexible Spending Account.  They work very similarly.  You or your employer can put money into this account to use only for health care expenses.  This is nice when you have a high deductible plan because then there is money set aside to help satisfy the deductible each plan year.  Also it gives you flexibility to choose what kind of health services you want.  This way you aren't just confined to prescription drugs and surgery at the hospital of the insurance company's choice.  Often the administrator of the account will provide you with a benefits card which will work like a debit card.

What Are These Things That Look Like Bills From the Insurance Company?

Whenever your insurance receives a bill from the doctor's office they make a decision as to how much they will pay.  They send payment and an "Explaination of Benefits" (EOB) to the doctor with the payment.  They will usually send or e-mail a copy to the patient as well.  This details how much was charged for each service provided (exam, adjustment, etc), how much the patient owes (co-pay, co-insurance, uncovered services, or deductible), how much the doctor writes off based on their contract and how much the insurance company will pay.  If they do not pay there is an explaination why they won't.

I hope that helps to clarify a bit how health insurance works.  It can be really confusing sometimes.  A thing that is widely misunderstood about helth insurance is the role it should play in your health care.  From time-to-time I hear people say things like "I can't go to the doctor because I don't have insurance." or "My insurance doesn't let me get chiropractic or massage".  WRONG.  Health insurance is not a permission slip.  You can go to whatever doctor you want wherever you want.  Insurance companies cannot direct the type of care you receive or who you receive it from.  They like pretending they can, but they can't.  They like to pretend that they can require you to receive specific tests or procedures, but they can't.  They like to pretend that they know how often you should receive treatment and how you should respond to care, but they don't.  They like to pretend that people who are not insured have no access to health care but that simply isn't true.

Health insurance exists to support care not to direct it.  Do you know who is really in charge of what kind of health care you have access to?  You!  Each of us gets to decide what kind of providers we want to see.  The question for many of us becomes… How important is your health?  You deserve an investment in your health and well being.  You don't want let a corporation who's primary function is to collect premiums to determine how healthy you deserve to be.

Here are some useful tips on how to use your money wisely to maintain your health with or without insurance:

  • Buy good food.  Good nutrition trumps most if not all medical intervention in terms of effectiveness and affordability for most of the deadliest and most debilitating conditions we face.
  • MOVE!  You don't need a gym membership to go for a walk, run or swim.  Exercise always has been and always will be free.  If you can afford a gym then use it!  Don't just make a monthly donation!
  • Focus on preventative health care.  Find doctors who come across as health gurus and coaches instead of drug dealers.
  • Avoid going into debt and work to get out of the debt you're in.  People who have debt are under a lot of stress.  Stress is one of the greatest contributors to poor health throughout the world.
  • Rest.  Good rest is just as important as good work.  Without appropriate (not too much and not too little) rest it is impossible to recover physically, mentally, emotionally and spiritually from the important things we deal with each day.  Building rest into your routine will keep you energized and healthy.

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