Eric Murray: Know thy insurance policy
April 27, 2008
I went to a chiropractor a half dozen times in 2007 and all I paid for was my co-pay.
My health insurance policy covered the rest as I expected. After each visit, I went home happy and adjusted without even thinking about the cost. (I pay several hundred dollars every month for this “luxury,” by the way.) To my dismay, this luxury of assuming my insurance will cover me changed this year.
You see, I just received an Explanation of Benefits or “EOB” from my insurance provider ” a document, not a bill, detailing what is and what is not covered. It explained that the spinal adjustment I had this March is not covered and it is 100
percent my responsibility to pay.
Sidebar: So as a relatively healthy guy with the occasional chiropractic adjustment, a healthy wife and no children, it seems I’m simply paying to the pool of reserves tapped by those who actually utilize my group insurance, as well contributing to the raw-profit of an insurance company selling me an intangible and historically unutilized service based on fear tactics. It seems obvious and financially responsible that I should look into canceling my policy, buying an $18 per month catastrophic insurance just in case and opening a personal savings account allowing me to actually keep my own money. Essentially, this would be like awarding myself with a significant bonus at the end of the year for staying safe and healthy.
More on this idea in another column.
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Back to the point, I suspect I’ll be getting a bill from my chiropractor soon.
If I knew that spinal adjustments were no longer covered under my policy I might not have participated in that strong man competition and pulled that 12-ton school bus up Red Dirt Hill leaving the competition in the dust but ultimately throwing my back out of whack. (Note fleeting attempt at comedy.) I suspect other insurance customers would behave differently as well if they knew how their insurance companies were weaseling out of responsibilities while charging more.
Wall Street insurance behemoths are certainly to blame, but ultimately I am upset at myself for not reading my policy thoroughly. No policy holder should assume their policy covers what it did the year prior. Even though policy holders are paying more in premiums they shouldn’t expect the same coverage no matter how logical that would be. “Don’t assume your policy hasn’t changed from year to year,” says Kori Dolph, Patient Financial Services Coordinator at Kremmling Memorial Hospital.
With rising healthcare costs and higher insurance premiums employers are faced with having to reduce scope of coverage in order to keep offering plans at all. It seems that in the current economic environment people are seeing everything cost more while getting less. Yes, I know there’s a word for it, inflation, but something seems especially unethical about health insurance.
Dolph reminds health insurance customers to ask questions.
“Don’t assume it’s covered,” she warned. “If you’re at a clinic ask to speak with someone from the billing department about your coverage or better yet call your insurance company.” Most insurance companies provide access to policy information on their company Web site. Insurance policy holders need to investigate what is covered in order to prevent the possible shock when the bill arrives.
She also suggests making sure your insurance card is updated regularly because sometimes the insurance company will add a digit to your I.D., which could lead to misidentification and delayed processing. Other information to be aware of includes knowing what providers are in network and which are out of network. It is important to understand how much your deductible is for various services as well as co-pay for regular clinic visits, ER care or specialists.
“We are ready to help you understand your bill and your policy,” said Amy Butler, Chief Financial Officer said regarding patient billing consultation. We have two Patient Representatives who specialize in billing and insurance issues available to help five days per week.
“A lot of people blame our billing at first and being human, sometimes we’re wrong and we fix it,” Dolph said, “but often times they end up seeing it has something to do with their particular insurance plan.”
The public is invited to attend an educational presentation on “Understanding Your Insurance Policy and How to Read an Explanation of Benefits, (EOB)”, on Tuesday, May 6, in the conference room at Kremmling Memorial Hospital starting at 6 p.m. Attendees are asked to bring copies of their policy or an Explanation of Benefits document if they want one-on-one assistance.
If this event is well attended, KMHD will offer similar educational events in other parts of the county. If you or an organization you belong to would like to arrange an event call me at (970) 724-3442.
“Becoming educated on how to read and understand this information can save a lot of frustration and money,” Butler said.
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