"No one knew healthcare could be so complicated." Going to have to say that one is false. I think American's would be hard-pressed to find something MORE confusing than our healthcare system. Kudos to our new administration for trying to tackle the 800-pound gorilla first, but looking back, maybe something less complex would have been the better move. I don't know, something simple like tax reform...
Young adults can probably relate to the processes of becoming an adult as a kind of "baptism by fire." From filing your taxes, to applying for jobs, to managing a full-time job rather than 12 hours of college classes a week, there are lots of firsts in this new time in our lives and many don't come with a manual.
The inspiration for this post is because I had one of these adulting moments arise yesterday. I returned home to get my mail and had an "Explanation of Benefits" from my healthcare provider, Anthem Blue Cross Blue Shield. With insurance, an annual physical is included with the premiums you pay as it is dubbed a routine yearly screening. For women, we also get other tests that are also covered annually.
I did my physical in early July at a doctor I found on ZocDoc in NYC. I knew to ask if everything was going to be covered under this annual comped physical...their answer was yes. They also ran blood tests to test for a variety of things. SO, all should have gone well, right? A $400 physical bill and $2,000 from blood tests...I would have to say no.
So here are the unknown missteps of my experience to hopefully help someone in the future not end up with a massive bill.
First of all is the basic task of deciding what you want to be responsible for paying AKA your deductible. The amount you pay monthly is your premium. This is the cost for having insurance whether you use it or not. When deciding your benefits (dental, eye, etc.) the higher your deductible, the lower your premiums. Your deductible is the amount you pay before your insurance kicks in. If you are fairly healthy and can absorb some doctors visits, choosing a high deductible will usually save you money in the end in terms of premiums.
Then comes co-pays. This is the amount you pay for going to see certain doctors (certain health plans don't have co-pay's.) Once again, if you're a hypochondriac and are at the doctor frequently, you would want to ensure you're paying extra in premium for a plan with no co-pay's to avoid a $50 fee every time you go to the doctor. For a general doctor visit, the cost is fairly low, maybe $25. When you go to specialists, eye, ear, nose & throat etc. the cost goes up. For urgent care and emergency rooms with our friends from Grey's, the cost for the co-pay is high but it is nothing like the bill that will come in the mail later.
I explain all of this because I have both high deductible's and co-pays, hence why I was responsible for so much of this bill rather than my insurance stepping in.
Questions TO ask. These are the absolute basics but I will leave you with what to ask for to ensure you are not stuck with a $2,000 bill also. When booking a new doctor, first of all make sure they accept your insurance carrier (Blue Cross Blue Shield, for instance.)
If you are going in for things like an annual physical and they want to run tests, first ask if all of these are covered under the yearly physical you are granted with your insurance plan. I would also get it in writing. They ran crazy tests on me like an EKG which is completely excessive, hence the charges.
If they are going to run blood tests, again, ask if they are covered. SECOND, doctors offices usually send this "lab work" out to a 3rd party. Although you may have checked that the doctor is "in-network" (takes your insurance) the lab might not be (as what happened with me.)
^Real photo of me when trying to figure all of this out.
If this happens to you, know there IS room for negotiation usually. I got on the phone with Anthem and had them dispute the charges and ultimately ended up getting the labs covered at an "in-network" cost. This will only happen if you're actively paying attention to your bills and taking the time to make the call.