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Yolanda Reid Chassiakos

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Think You're Covered? Think Again!

Posted: 08/17/09 06:34 PM ET

While comforting her daughter on the way to the nearby emergency room, Maria had a thought she didn't express. "Times are tough -- I'm so glad we've got health insurance." Ana's cut just above her forehead was still bleeding, and would probably need stitches. At the hospital, which was listed on her insurance plan, Maria was relieved when the doctors told her Ana's head injury was minor and that they'd fixed her cut so it would quickly heal. A week later, as she watched a recovered Ana happily resume active play with her friends outdoors, Maria opened the letter from her insurance company. And gasped. Thanks to her insurance, the ER visit would only cost her $50, as she'd expected. But, despite the insurance company's contribution, the bills didn't stop there. The total charges Maria faced paying for Ana's care in the ER topped three thousand dollars!

We've all heard about the heartbreaking cases where insurance companies have canceled coverage and refused to pay hospital bills for patients after they've received treatment. But, as in Maria's case, even when the insurance company forks out their required share, patients and their families could still be on the hook for big bucks. When she aimed for her "in-plan" emergency room, Maria didn't know that, while the ER itself was "in-plan," its doctors, hired on contract, were not. And, the CT scan they'd ordered to ensure that Ana didn't have bleeding on the brain, performed in a trailer adjacent to the hospital, had been done by a partner company of Radiology doctors, who -- you guessed it -- were also not participants in Maria's preferred provider insurance.

Because the ER and the X-ray doctors were "out of plan," Maria's insurance company would only pay 60% of their fees, not 80% as with "in plan" providers. To her dismay, Maria quickly discovered that, for out-of-plan providers, the insurance would pay 60% of the rates it had negotiated with in-plan doctors. Anything over that became Maria's responsibility. In-plan doctors might bill the insurance company $500, of which $400 would be paid by the insurance company and $100 by Maria. Out-of-plan doctors who had no deal with the insurance company could charge much more -- $1000, for example -- for the same service. The insurance company would then pay 60% of the $500 agreed upon for in-plan doctors -- not the $1000 demanded. The final insurance payout would be $300 and Maria would be left with a $700 bill. Had the ER warned Maria that their doctors' services might be out-of-plan so that she could opt to go to another facility? Not a chance.

As a doctor, I've seen many cases like Maria's, where patients think they're abiding by insurance company rules, only to find that their final bills are overwhelming. That's why it's critical for everyone who "has health insurance" to "read the fine print" and develop an "emergency preparedness plan" for healthcare that ensures you or your family won't be caught in a financial bind in case of illness or injury. Here are six steps to giving your insurance a "check-up":

  • First, pull out and read the insurance company contract. Are there any exclusions, areas or types of care that are not covered? If so, you may need to consider buying a supplementary insurance plan or investing in a medical savings plan -- in advance.
  • You probably have your favorite doctors -- but are they still part of your plan? Contracts between insurance companies and medical groups or practitioners change frequently. You may want to review and ensure that your doctor is still participating in your insurance plan on at least a quarterly basis.
  • Your local hospital or hospitals may also have agreements with the insurance plan, but, as in Maria's case, some of their contractors or partners may not. Your quarterly review should include clarification of what hospital services are "in-plan" and what services may be or may have become "out-of-plan."
  • Once you've identified the doctors and health care facilities you may be visiting, and ensured they're "in-plan," develop your own "healthcare emergency plan" in case of illness or injury. Designate which doctors you will try to see, and which hospitals/ERs you are going to patronize in advance of need.
  • If you have an emergency that is handled by a 9-1-1 call and subsequent ambulance transport with emergency medical technicians, you may not have a choice about which hospital the ambulance is directed to take you. Obviously, your medical condition will guide the EMTs and the doctors -- the nearest hospital may be a life-saving choice, even if it's not a participant in your insurance plan. The EMTALA law requires that all ERs see and treat all patients until they are medically stable -- whether or not they are insured. However, less critical "emergencies" may afford you some input into the ambulance team's decision where to drive you -- don't be afraid to suggest a particular ER close by that is within your insurance plan.
  • Finally, after a service is provided, remember that many healthcare bills are negotiable -- even with insurance companies. Do try to appeal an insurance company decision if you believe you were treated unfairly or erroneously. And, you might also be successful if you approach non-plan doctors and ask if they might consider reducing their charges in your case to the level of in-plan reimbursement to reduce your out-of-pocket costs.

That's exactly what Maria did. Fortunately, the out-of-plan doctors agreed to reduce her charges to her plan levels in her case, resulting in a much more manageable bill for Ana's ER visit. Maria hopes Ana won't need another ER visit in the future, but, with her own "healthcare emergency plan" now in place and up to date, Maria knows if illness or injury strikes, she'll be prepared to do the best for her family, medically and financially.

 
 
 
While comforting her daughter on the way to the nearby emergency room, Maria had a thought she didn't express. "Times are tough -- I'm so glad we've got health insurance." Ana's cut just above her f...
While comforting her daughter on the way to the nearby emergency room, Maria had a thought she didn't express. "Times are tough -- I'm so glad we've got health insurance." Ana's cut just above her f...
 
 
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09:41 PM on 08/17/2009
Part 3) My husband and I pay $50 a month for our medical premium in BC. If our income is lower, the premium is lower, or even nothing. In many provinces, premiums are free. That covers doctors visits, technological test, blood tests, hospital care, operations, etc. (Not cosmetic surgery that isn't medically required.)

When I read consumer information for Americans about choosing a health care plan, it makes my head spin! And then, even if you think you have chosen well and you can afford it, they can do things like this article outlines! Or you have to get an advocate to fight for you if they refuse to cover something! AND we don't have to fill out complicated papers for every procedure we have.

My father had a heart attack after paying into Blue Cross for many years. They refused to cover much of his care and he ended up losing everything. Fortunately, my parents were able to move to Canada where we have alot of family. He had the best of care and was able to let go of the stress of worrying about medical bills in his later years.

Please don't let these morons bully you out of what is a right , not a privilege, in every other civilized country!
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Romulus
11:06 AM on 08/18/2009
So who pays for all of this? It's unlikely that $50 a month will cover all your eventual medical expenses; it's a certainty that those who pay no premiums are not covering their expenses. So who pays for them? Taxpayers, right? Those who make enough money pay for those who don't, right?

So when you say that complete medical coverage is a right, you're really saying that those who don't have money have the right to other people's money. Perhaps you can explain why this is so. why taking other's money is a right.
03:11 PM on 08/18/2009
71 % of health care is paid for by various levels of government, yes. Why is that any different than our taxes paying for schools and roads? Should poor people have poor schools and roads, as well as poor (or non-existent) health care? Children can't help what circumstances they are born into. I would rather pay for someone else's health care than for a huge military machine. personally. Here is a short explanation of how our health system works:

"Health care in Canada is funded and delivered through a publicly-funded health care system, with most services provided by private entities.[1]

Health care spending in Canada is projected to reach $160 billion, or 10.6% of GDP, in 2007. This is slightly above the average for OECD countries, and substantially below the 15.2% of GDP taken up by healthcare in the United States.[2]

In Canada, the various levels of government pay for about 71% of Canadians' health care costs, which is slightly below the OECD average. " Full article here:
http://en.wikipedia.org/wiki/Health_care_in_Canada
05:07 PM on 08/19/2009
Boy is Romulus' thinking twisted. Hey Romulus why is health care different than Police protection. The poor don't have the money to pay for Police protection so the taxpayers with money pay for the Police. Why do you not feel that Health Care is not as Important as Police protection. I certainly do.

Romulus, you need to think things out logically. Stop listening to People who have agenda's that are not in the best interest of America.
09:41 PM on 08/17/2009
Part 2) I am so glad that my mother moved up here, too. She is 91. Last Thurs. they found that her iron blood count was super-low. Tomorrow she goes into hospital for blood transfusions. So much for the lie that elders don't get good care with socialized medicine! When she broke her hip she was immediately operated on and had physiotherapy right way, and recovered nicely.

And we don't have to worry that the health plan is going to decide you aren't eligible for a certain procedure either. Canadians (and the rest of the civilized world) don't understand these movie plots in American movies that revolve around a parent trying to get care for a sick child when they have no health insurance. This is insane! Why do you put up with this?? The US is the only country in the First World that has such an unfair system.

I just don't understand this insane "freedom" thing in relation to health care. We Canadians are free from worrying about medical bills like the one described above! We are free to choose our own doctors! We can have a baby at home with a registered midwife if we like and it's on the plan. Having a premature baby will not bankrupt you. And we are just as much a "democracy" as the States. So is France , the UK, Australia, etc. What is the matter with these people!!! I just don't get it! (see part 3)
09:40 PM on 08/17/2009
Part 1.) I'm sorry, I just can't be quiet anymore. I was born in the States and still have relatives and friends there, but I have lived in Canada for most of my life. This would just NOT happen in Canada! Don't believe all the lies you hear about the Canadian system. It's not perfect (probably not as good as France's), but that's because we have a Conservative government that doesn't fund it properly.

But, please hear me-- we choose our own doctors and we have more choice than you do because we do not have to choose one who is connected to a certain plan! I live in a small community with 3 doctors who choose to work part time. I can go to all three, and I do, because each one has certain strengths. (However, I choose to have a healthy lifestyle, so I don't see them often.) The medical plan in BC also pays for some chiropractic, physiotherapist, massage, and naturopathic care, if you are low income. Your personal doctor can refer you to a specialist. Registered midwives are on the medical plan, too. (The provincial plans are all a little different.) (see Part 2)
07:21 PM on 08/17/2009
Your comment sums up the flawed thinking that places health care in the same category as a buying a TV - as a consumerist rational purchase responsive to free-market forces. It's crazy to think we can approach health care the same way we would go about buying a new sofa.

A better comparison is to suppose that police coverage was all privatized and offered by different companies at different rates, and expect a 911 caller to first shop around for the best deal on protection from the carjacker knocking on their window.
07:03 PM on 08/17/2009
What's wrong with the health care system? You've named it in detail.

Compare this with any other kind of insurance:

If the body of your car is injured, you don't have to worry whether the paint-spray operator is "in the plan" . Why should you have to worry about it when it's your own body that is injured?

They only pull this stuff because they can get away with it. They shouldn't be able to.
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bitohistory
08:34 PM on 08/17/2009
Good post, Paul.
The same people that do air fares do health ins........Oh do plan on getting sick on tues or thurs ?Then its $$ much. Friday to Monday it's $$$$ ...etc