If you’re like many people, you probably spend as little time thinking about your health insurance as possible.
Your premiums come out of your paycheck, so you don’t even have to think about it every month. Then when you get sick, you assume the insurance will take care of it.
But when you think about the statistics, you might conclude that your health insurance deserves a bit more thought than you’ve been giving it. According to the World Health Organization, 64 million women in the U.S. have at least one of the “big 6” health conditions – heart disease, cancer, hormone disorders, diabetes, joint conditions, and mental health issues.
Men have a different set of top concerns, but they are just as serious. Heart disease, cancer, stroke, chronic obstructive pulmonary disease and suicide risk are some of the top risks for men.
When you are healthy, you many not feel the need to worry about your insurance. But if you get sick, you’ll find out in a hurry just how important it is to understand your insurance policy. The reality is that insurance coverage only takes care of certain things. If you don’t know what your policy says, you may find yourself with a big, unexpected bill for things your insurance didn’t cover.
To help us understand more about health insurance and what to watch out for, I talked to healthcare executive and former Chief Medical Officer of United Healthcare Dr. Archelle Georgiou. Here are some of things she explained to me:
• In Network Providers - Most health insurance companies have negotiated contracts with doctors, hospitals and other services. So, when you go to an "in network provider" you don't have to pay the provider’s retail fee for your care. Since insurance companies represent millions of consumers, they can on average negotiate a 40-50 percent discount off the retail rate.
• Out of network (OON) providers – These are doctors and facilities who do not have a contract with your insurance company. That means they have not agreed to accept the amount your insurance is willing to pay as full payment. No matter what OON providers decide to charge, your insurance will only pay a "reasonable and customary" price for services you receive. It will be up to you to pay the difference out of your own pocket. And depending on what you have done, that could be hundreds or thousands of extra dollars that you owe to the OON provider.
Based on what Dr. Georgiou explained to me, you are always better off financially to choose a network provider as your doctor or healthcare facility. But don’t think I’m saying you should never go to an out of network provider. If you have a serious condition and the top expert in your area is not on your insurance, you may decide his or her expertise is more important than the extra costs. Or if you live in a small town, you may have limited choices for doctors or facilities. The point I’m trying to make is that the decision is yours whether you chose to use an out of network provider or not.
As your own health advocate, you need to decide which insurance policy or provider is best for you, and what doctor or facility is going to give you the best care. My advice to you is to read your insurance policy carefully and be aware of whether you are seeing in or out of network provider so that you don’t get surprised by unexpected charges.
There is a lot more I want to say about insurance, including advice from Dr. Georgiou about exclusions to your policy and why you need to know what they are. We’ll talk about that next time.
You can find more tips from Dr. Georgiou here on EmpowHER and check out her blog .
Edited by Jody Smith