When it comes to health insurance cards, there is a major mis-understanding of how they work and what good they are, and if in fact they are any good at all.
Again, having spent 14 years in the field of health care, I have witnessed first hand peoples confusion about health insurance and how it works. The first thing most people look for, or ask, is
- "Do you accept insurance?" or "Are you in my insurance network?"
- "What will my insurance cover?"
So lets say for example, you have a rotator cuff strain. The insurance company may only allow 10 visits to heal your injury, and if you are not healed within that time frame, then too bad for you, because your insurance company will not cover any more treatment. Which means that you will have to pay out of your own pocket for the remaining treatment.
- "How much will it cost me?"
FIRST - you have to find out what your deductible is. If you have a $2000 deductible, that means that you have to pay for the first $2000 worth of care before your insurance company even considers you (there are some exceptions to this rule).
SECOND - you have a co-pay per each office visit. Your co-pay could be anywhere from $5 per visit to $75 or more per visit. So you again have to cough up that money every time you go to the doctor (again with some exceptions).
So let's put this all into perspective. Let's use the example of a rotator cuff strain that you need 15 visits to recover from. Using the examples above, assuming your initial physical therapy exam and consultation at a cost of $250, plus treatment at a cost of $180 per treatment plus your evaluations at $125 per evaluation (let's assume you only need 2 evaluations). You are looking at a total cost of $3200.
Ok, here is the insurance breakdown: you are responsible for the first $2000 because of your deductible. So you are paying cash for the initial exam of $250 + 9 visits @ $180 per treatment + your first re-evaluation @ $125.
Now with 6 treatments remaining + your final evaluation, your insurance company will consider reimbursement. For these 7 treatments you have a $50 specialist co-pay, which means you owe another $350 out of your pocket. This means that of the $3200, you had to pay $2350. But it does not stop there.
It took 3 months for you to complete care. Because your insurance company was collecting your $300 monthly premium for each month, you actually paid $3150 for your care. So of the $3200 total cost, your insurance company actually only paid $50.
Now let's take for example, I have no insurance and I want to pay cash. Well, the physical therapist offers me a 25% discount if I am a cash patient. So instead of me having to pay $3200, I only have to pay $2400. And because I do not have a monthly premium payment, my actual savings is $750.
Keep these things in mind when you are choosing whether or not to purchase health insurance and your specific needs. There are a lot of other options available to you other than the traditional insurance plans, for example a Christian Shared Ministry health insurance, or even your own self funded health savings account.