Insurance Center Group
A member of the PROES Group
Mon. ~ Fri. 8am-5pm
Oct 12th, 2020
Covered: The Health Insurance Term You're Misusing
Our agents hear it all the time, “is it covered?” You’ve probably asked this question before when buying health insurance, be it out loud or just in your head. Before every doctor visit or procedure, I ask it myself, too… However, I’ve only recently realized that what I’m asking is not what I really mean…
Say What You Mean and Mean What You Say
For me personally, when I ask if something is covered, what I really want to know is if a certain service is free. If that’s what we really mean, why don’t we drop the ambiguous language and just ask? Doing so could clear up a lot of confusion, because asking if something is covered does not necessarily mean free in the world of health insurance.
A health insurance agent has a different definition of the word covered than you likely do. To them, when a service is covered, your insurance company pays for all or some of it be that through a copayment, deductible, coinsurance, or other stipulations written into your policy. To an agent, “covered” means that your plan will at least help pay for a service.
Covered Does Not Mean Free
When I first learned about the Affordable Care Act/Obamacare, I read that a list of essential health benefits were required to be covered by Marketplace plans. At the time, I had a Marketplace plan and needed to have an antibiotic prescription filled. An essential benefit that was required to be covered is prescription medications. When I had to pay a whopping $10 for my antibiotic, I was wildly confused. I thought my prescriptions were “covered”… Now I realize that they were covered, they were just subject to my copayment. My insurance company helped pay for my prescription, they just didn’t pay for all of it.
I’ve also had various tests completed by my doctor when enrolled in a Marketplace plan, again thinking they were covered (per my definition- i.e. free…), and then being outraged when I still received a bill in the mail. After further investigation of my plan and its summary of benefits, I again had the realization that covered did not mean free and that many of the tests I had done were subject to my coinsurance and deductible. This meant that my 20% coinsurance (I pay 20%, my insurance provider pays 80%) didn’t even kick in until after I met my $1000 deductible. I hadn’t met my deductible, so I paid for the tests. Again, these services were technically covered, just subject to my coinsurance and deductible.
When in Doubt, Ask
When you speak with an agent to enroll in a health plan, be specific with the questions you ask. If you want to know if something is free, simply ask that question. If you still want to ask if a certain service is covered, ask how much is covered and how much you’re responsible for paying. Doing this is one of the most effective ways to ensure that you know what coverage you are getting, and also the most effective way to make sure you and your agent are on the same page. This way, you can avoid the confusion of a surprise medical bill because you’ll already know what’s “covered.”
We are an independent agency providing for all your insurance needs in one place. Our personnel brings over 84 years of combined experience to help you improve your insurance situations and fulfill your needs.
We are a member of the PROES Business Group. This association is a family of companies providing multiple avenues to make your life better. It brings business partners with the right background, experience and expertise to help you with your needs.
Each agent, servicing representative and owner’s philosophy is to combine quality, price, experience and service in every facet of your insurance purchasing experience. We strive to build long term relationships by meeting the needs of our clients.
The various backgrounds of our people help assure we can relate to your situation. Our goal is to help you have the right coverage, at the right price and be satisfied at the most important time – when you have a claim. We understand you are not buying insurance: you are buying piece of mind to protect yourself, your business and your family.