Are You Insured for an Emergency

Are You Insured for an Emergency?

There is an ongoing drive to send patients to urgent care clinics or your doctor’s office rather than then emergency room.  It can save both you and your insurance company money.  There are exceptions to the rule of course, if you are referred to the emergency department by your doctor for an x-ray or other non-emergency services.  The exceptions also include situations where the nearest clinic is too far away, it is the weekend or if you are bringing your child.  When an actual emergency happens very few consider whether they are covered they are more concerned with getting to the doctor.  But the question remains, are you insured for an emergency?

Going to the ER

There is a lot of grey area when it comes to defining what an emergency is.  The ACA defines it as “a prudent layperson, possessing an average knowledge of medicine and health”.  That doesn’t help much, since you need to see a doctor first before they can determine if this is a real emergency or not.  You as the patient or parent of a patient has to decide if your illness is worth an ER visit and whether you can afford it.  Here are some situations where your visit may not be covered.

A Genuine Emergency

There are times that are genuine emergencies such as accidents or coronary events and you need to get to the ER now.  But if you ever look around the waiting room of an ER there are plenty of people there with headaches, colds and sore throats which can be treated at a clinic or at a pharmacy.  If you are unsure, then before you head to the ER let’s look at some alternative options.

  • Try a virtual doctor, you can speak with a healthcare professional online and determine if you need the ER or not. This is a new tool for the healthcare industry and lots of insurance companies will cover this option for you.
  • Visit a nurse at a drug store, many of them will be open for consultations outside of business hours to see you.
  • Use a Medical Cost Sharing program, often these are organized through your church where the participants support each other’s costs.

Read the Fine Print

Always read your insurance policy to understand what and how emergency care is covered.  You need to understand how your insurance company defines an emergency and what they are going to cover.  The cost of healthcare is rising, with less coverage and higher out of pocket expenses and the onus is on you to understand your policy.

If the emergency is not one that is covered and you have a bill from the ER then check with the hospital to see if you meet the guidelines for financial assistance.  Don’t make the mistake of assuming these programs are just for the uninsured or low income families.  There are programs for patients that have their own insurance so check to see if you qualify.

3 Essential Tips for Buying Health Insurance

3 Essential Tips for Buying Health Insurance

If you don’t have health insurance through your employer and have to buy it individually it can get complicated and expensive.  The number of health plans that are online is overwhelming and you probably aren’t sure what you need.  Health insurance for most people is one of the more expensive items in the monthly budget so you want to get it right.  Here are 3 essential tips for buying health insurance that will help you get the coverage you need at a price you can afford.

Get Advice from an Expert

Everyone will have opinions on which plans you should choose, that doesn’t mean they are qualified to give you an opinion.  Don’t take advice from friends or relatives even those that work in the healthcare fields but rather talk to an impartial insurance expert.  Insurance specialists know the ins and outs of the policies and can help you make an informed decision that works for you and your family.  These specialists are compensated by the insurance companies and not you so their advice is usually free.  These people are experts, use them.

Figure Out What You Actually Need

This is again where a specialist can help you, but to determine what you actually need ask yourself how often you need to see a doctor.  Are you healthy and only go for annual checkups or do you have a condition that needs continuous monitoring?  Have you been in the hospital in the past few years?  Do you need regular medication?  A specialist can help you find a plan that will give you the maximum coverage where you need it the most, be that prescription drug coverage or hospital coverage.  Insurance agents also have access to plans that aren’t necessarily advertised on so take advantage of that.

Don’t Overinsure

There are plenty of people with individual health insurance plans who actually have too much coverage.  You are probably thinking that’s not possible so here is an explanation.  If you are young and relatively healthy and don’t need ongoing doctor visits but you have preventative care coverage at 100%.  Sounds good, but you can enroll in a plan that instead has a lower premium and opt for a $10 copay you can potentially save yourself hundreds of dollars each year.  Also you should note that some of these plans with maximum coverage won’t cover everything, pregnancy is one example.  This is why you should talk with an expert, you get the coverage you need at a price you can afford.

Health insurance is confusing, you want to have insurance in the event that you do get sick or injured and at the same time not pay for things you will never need.  Speaking to an expert can help make this much less confusing and help you get the right coverage.