So let’s be honest…reading your health insurance policy or Explanation of Benefits (EOB) is a lot like reading the tax code.
Insurance companies seem to have figured out every scenario that may cost them money (explains industry’s hefty bonuses), resulting in a large number of benefit exclusions. Unfortunately, this seems to occur most often when you need the coverage. For instance, a friend just went off COBRA and bought an individual insurance plan for his newborn and himself. His wife had a non-surgical shoulder problem a few years back so was rejected coverage from BC/BS, but got a policy through the state’s high-risk pool with BC/BS – go figure. His baby had GERD when it was born, which is very common in newborns, but my friend was able to get coverage due to the PPACA’s pre-existing condition for children mandate. However, the policy had a 90-day waiting period for well baby care coverage. Hmmm…so do you wait to take your newborn to the doctors and delay vaccines and check ups or pay out-of-pocket? Like most new parents, my friend took his new son to the doctor and now has a $1,000 bill to pay on top of the 30% higher monthly insurance premium for a baby with GERD.
Why should we pay for premiums that don’t cover what we need? Health insurance is a one-size fits all product that makes the majority of us either underinsured or overinsured. The real benefit of insurance is catastrophic insurance — protecting yourself should something happen to you or a family member that requires high levels of medical care. I really feel for people who have chronic conditions and have to manage monthly bills against deductibles, exclusions, co-insurance rates and co-pays every single month. The worst part is that when you get sick, insurance companies treat you like undesirables. But come on — babies! Newborns! How can there be a 90-day waiting period for care? You’re only 1, 2 and 3 months old, once time in your life.
