I must admit a deep sense of relief that we have finally passed some kind of health care reform in this country. Although I am still unsure what is actually changing, or when we will see the transformation (2014 seems a long way off), I do agree it is an historic shift towards a consciousness of "inclusion." Allowing 32 million Americans to live uninsured could not remain a public option.
For those of us who have medical insurance, what happens now? Will we see change also? Apparently, not much -- other than a continuation of the vicious cat and mouse game the insurance companies play to confuse, confound, and cough up as few services as possible from your policies.
If the outrageous premiums weren't enough to test your commitment to inner peace, the constant denials of coverage, outlandish premium increases, and dragged out reimbursement process that requests ridiculous amounts of irrelevant information, makes Rambo's approach to problem solving seem at times a lot more rational than that of Gandhi.
The only thing that has kept me sane is having an insurance agent that truly cares, a commodity rarer in this world than diamonds. Without the dogged determination of Jennifer Alamdari at Farmers Insurance, (whom I liken to either Al Pacino in And Justice For All or Julia Roberts in Erin Brokovich) my family would have endured unlimited financial, mental and emotional pain. We would have:
➢ Seen our premiums double in less than 12 months because insurance companies don't let the public know they have hidden plans that are cheaper.
➢ Seen our deductibles triple (rise from $1500-$7500) because it would have been the only way to keep our jacked up premiums down.
➢ Seen the money owed us after doctor visits and medical procedures line our insurers pocket, not ours. (New York City doctors are so enraged by insidious insurance company practices they make you pay up front now for everything).
➢ Still been on HOLD, because they never friggin' pick up their phone!
Health care reform is not going to change any of that. Which is why I asked Jennifer to share her seven TIPS for successfully navigating our present medical insurance labyrinth, designed to deceive, deter and demoralize you from getting what you paid for. Here's what she recommends:
TIP#1: Understand your coverage thoroughly
Educate yourself about the difference between a deductible and out of pocket maximums.
What is your office visit co-pay? Is it subject to the deductible? What do you pay for lab work? What about prescription coverage? Is there a deductible for that? Do you have brand name coverage or generic only?
TIP#2: Be your own advocate
If a claim is rejected, do not accept it as the final word. Check your policy and see if it is indeed covered, then prepare to fight. Make calls, write letters, send faxes. Telephone to make sure your letters and faxes have been received. When you speak to someone, note their name and the number you called to reach them. Then call back and speak to someone else. Errors are not only possible, but probable.
TIP#3: Keep a current health file
Keep a file on each family member with all the medical bills placed inside. Start a new file on your policy anniversary date. This is to track your deductibles so you make sure you are receiving all your benefits.
TIP#4: Understand "In Network" vs. "Out of Network"
When you find a doctor or are referred to someone make sure they accept your insurance. If they do accept it, don't stop there! Make sure your insurance agrees that they are "in network." If you think you will pay 30 percent for a procedure then later find out you have to pay 60 percent because the physician was out of network you will endure unnecessary pain.
TIP#5: Make sure your policy fits your needs
I have had clients who rarely go to the doctor, their kids are grown and out of the house, and their health policy had a $500 deductible with maternity coverage. Conversely, I have had a young family for whom every dollar counts get a policy with a $10,000 deductible and no maternity coverage. For $2,400 more per year in premium they could have coverage that would allow them to save $2,400 or more per year in out of pocket medical costs. Reassess annually and don't be afraid to make changes.
TIP#6: Take advantage of what your employer offers
Many companies offer cafeteria plans--these are a great vehicle to set aside money pretax which can go toward medical expenses, be they premiums, co-pays, or alternative therapies that may not be covered by your plan. If you don't understand this, call Jennifer and she will explain!
TIP#7: Find a doctor who will work with you, they still exist
Many doctors will work within your plan if you simply outline for them what you are covered for. Doctors are pressed for time and will diagnose you and prescribe a course of treatment in the blink of an eye without thought to what you can pay or are covered for. Why should they, unless you bring it up.
Examples: Ask them if their nurse can draw blood; it can reduce lab co-pays. Ask if the drug they are prescribing is a formulary or non-formulary one. Better yet, ask if there is a generic version. Create a team who will help you get the most out of your benefits.
Personally, I'm tired of being the mouse in a game of cat and mouse! I hope you are too!
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