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.