I don’t know about you, but I love television shows like The Good Doctor and Scrubs. Just because I’m a fan of these however, didn’t mean that I understood what surgery would be like for myself mentally nor financially. Going through my recent experience, it made me wonder if everyone lives each day prepared for the ER or if people live more like myself; unprepared and vicariously through these shows. It made me wonder if people actually know what their insurance plans cover.
Knowing your coverage is essential when it comes to making important decisions as not every facility is going to understand your plans limitations. My first hand experience helped me ask this question, since my own insurance was about to not cover what we originally thought. In my case this was because of an “in network/out of network” issue. What this means is that in network health care providers have contracted with your insurance company to accept certain negotiated rates. Out of network providers have not agreed to the discounted rates, which means you may be charged the full amount for your treatment.
Lucky for me, there was just some minor confusion and everything was sorted out in my favor. My surgeries are a continuation of in-network emergency procedures. My facility was in network for hospital/emergency, out of network for surgical care. Because of my plan, there is an out of pocket max for out of the network of $6,500 a year. Meaning I can’t spend more than that on out of network procedures. With COVID-19 typical procedures have all changed momentarily as well. Knowing this helped me find the solution to my problem with billing, and also thanks to one BADASS head plastic surgeon.
Can you imagine being told that everything after your initial ER visit is actually not in network- so if you’d like to continue with your current (now out of network) team you’ll be footing the entire cost of each surgery (around $35k per). Sure you will be reimbursed around 95% of the money some months later, but do you have the ability to withdraw $35k from your bank account and not worry about when you’ll be paid back? To just waltz right in to your bank and ask for a check of that size?
Most of us are going to say no, that’s not even remotely close to reality for the majority. Very few would be able to cut 3 separate $35k checks in 6 months and not worry about when that money will be seen again. This is why no matter what stage of life you are at, no matter what your savings account looks like at this very moment… insurance is important. Yet the most important part of all – is knowing your insurance. Having the ability to talk to your agent, ask every important question and get all the information you can is essential.