By Ryan D. Hall

Medical insurance is not an option. If you don’t currently have coverage, consider this. I recently took an unplanned trip to the ER and the resulting bill was $6,000. Because of my insurance coverage, my part was only $150. Now imagine what that amount would be if I was uninsured and had required emergency surgery. Insurance coverage is changing. Something that used to be simple and straight forward is now complicated and confusing. Many insurance companies are taking advantage of unsuspecting people and they are none the wiser. That is until they get the bill or are denied coverage. So let’s talk about what to look out for, so you don’t end up like so many others.

Shop around. There are hundreds of plans available which can be compared side-by-side online. Use several of these websites to compare as many plans as you can. Even if you already have an insurance plan, it have may have changed and may not cover you as well as you think. Also make sure to read the fine print. It seems like common sense, but the vast majority of people don’t know what their coverage is. They simply find comfort in having insurance. This false sense of security is not enough. Everyone should read every detail of their policy. If you need further explanation, call the number on your insurance card.

You get what you pay for. Medical costs continue to rise and medical insurance is not cheap. If you’re getting a “deal” on insurance, odds are your coverage is not the best. If you currently have, or anticipate having high medical costs, it usually pays off in the long run to have better, more expensive coverage. Secondary insurance may also be necessary. If you have insurance provided by your employer or are covered by Medicare, be sure of what is not covered. Medicare typically does not cover 20% of your medical costs and many employer provided insurances cover less. If you anticipate large medical bills, 20% can still be thousands of dollars.

Watch out for HMO’s. These plans are often cheaper, but limit which health care providers you can see, charging much more for “out of network” providers. In fact, you should avoid any insurance with “network” in the name, as they often have the most limitations. In fact, the number of yearly physician or specialist visits is usually restricted to just a few in these plans. This includes chiropractic and physical therapy visits. Beware of “advantage” plans. Many insurance companies offer these plans, claiming they will provide you with better coverage with less cost. The problem is that they do this by restricting your benefits. Often times these companies will tell you that you have a certain amount of physician or specialist visits covered. What they don’t tell you is that they will not reimburse these care providers beyond the first few visits, forcing them to charge the patient more or discharge them earlier than other patients.

So, whether you currently have medical coverage or not, think about the options. Remember that a cheaper plan is usually not a better plan. Compare as many plans as possible. Read the fine print, or call the provider. Be leery of HMO’s or anything called “network”, and so-called “advantage” plans. Check to see if you need secondary insurance.  Most importantly, make sure that you stay informed about your current plan and about any policy changes that might occur. It might just save you thousands of dollars or ensure that you get the care you need. Let’s stay healthy Milan!


Ryan D. Hall, PTA, CSST


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