1. “Your deductible is only the beginning.”
Ellen Stephenson, 57, was fully insured when she was diagnosed with an aggressive form of breast cancer eight years ago, so she never imagined she would be on the hook for $100,000 in medical bills. But after meeting her plan’s $3,500 annual deductible, she has to pay another $40 for each doctor visit and another $250 for each test. Over years of treatment, those extra costs have added up, and there’s no end in sight. She’s still being treated for the cancer, which has spread to her pelvis, spine, brain and lungs. “It’s a challenge,” says Stephenson, who was the director of a nonprofit before her illness. “I don’t know what will happen, but right now my physician’s office is very, very kind and is working with me.”
Consumers typically assume that once they meet their health plan’s annual deductible, the plan pays the rest. Not true, says Nancy Metcalf, a senior program editor at Consumer Reports Health, who notes consumers still often have to kick in thousands of dollars in co-pays and other expenses. And those costs seem to be rising.
[This is one of the reasons why we at Lehrman Group recommend HSA-compatible policies. Your out-of-pocket exposure is definitely limited on HSA plans, and you'll always know what your maximum annual exposure is.
2.”We will pay out-of-network expenses.”
Yes, there are times when insurance companies will completely cover care even if it’s provided by an out-of-network provider. That typically occurs when a plan covers the treatment but an in-network provider – often a specialist – is not available close to home or when there’s an emergency and you have to get care at an out-of-network hospital. If you know ahead that you’re going to an out-of-network provider because no one is available in your community, get the insurance company’s permission in writing, says Helen Darling, president of the National Business Group on Health, a nonprofit association of large employers. That way, months later if the insurer disputes the claim, there’s proof of the agreement.
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