Realistically, we know we need health insurance. It’s one of those things that’s required to be a semi-responsible adult, like flossing regularly and cleaning out the gutters. But the insurance companies don’t always make it easy to understand what exactly we’re getting when we sign up for coverage. We can even go to a doctor and think it’s covered under insurance, only to get a bill for hundreds or even thousands of dollars a few weeks later. It can be confusing, but as with most things, education is your friend. It’s also your best chance at getting the most out of your coverage, regardless of how much you are or aren’t paying for it.
The state of insurance
A few years ago, you probably heard that you had to have some kind of health insurance or risk getting dinged on your taxes. In the last few months, you might have heard differently. This is a weird case where both things are right. When it passed in 2010, the Affordable Care Act (sometimes called Obamacare) required most Americans to have health insurance or pay a penalty. The so-called individual mandate is one of the least popular parts of what’s otherwise a fairly popular bill (the poll numbers might have been boosted by repeated Congressional attempts to repeal the law once President Trump took office). While Congress failed to repeal the lawfully in summer of 2017, Congress repealed the individual mandate in December of that year. The mandate is still in effect as of 2018, but starting in 2019, you can not have insurance and not have to worry about any sort of penalty (other than the penalty of possibly being unable to afford basic health care). But other aspects of the Affordable Care Act are still in place, even if the health place markets are sturdier in some states than in others. The future of “Obamacare” in general is still uncertain, but right now it’s still the law of the land.
Understanding your options
Not surprisingly, voters are highly concerned about health care heading into the 2018 midterm elections. In spring 2018, 55 percent of respondents told Gallup that they’re worried “a great deal” about their ability to obtain and afford health care. You should feel free to express any concerns about the law to your local and state legislators, but you should also talk to your doctor. Even if your doctor doesn’t know a ton about what your insurance will or won’t cover, there should be a billing specialist in the office who does. You may also be able to log onto your health insurance provider’s website and check out a policyholder portal module with more information on things like deductibles and premiums.
If your doctor’s office or hospital uses a word like “pre-approval,” that means they have to get approval from their insurance company before they can treat you. It’s not required for everything, but it’s common for anything outside of normal preventative visits. If you want to see a mental health specialist, you may very well need pre-approval. Without it, your insurance company will probably reject your medical professional’s claim outright, which means they then have to bill you for the full cost of treatment. If you’re billed for something after you thought it was approved, be prepared to make a lot of phone calls in order to resolve the issue. It may be frustrating, and you may have to work your way up the telephone ladder at your insurance company, but being polite yet persistent is your best shot at getting answers.