Saturday, October 24, 2009

Catastrophic health benefit --Misleading disaster?

Most health care plans today have what is referred to as "Annual maximum out-of-pocket cost."
While most believe this is supposed to put a financial ceiling on a health catastrophe, I'm not sure that's anywhere near accurate.
It may offer comfort on paper, but in practice, that's doesn't look to be the case.
I know several people in the past year who have paid three to four or more times more than their so-called limit and all their bills aren't even in yet.
One person I know is on a plan with a $1,500 limit per person a year. However, the family has now paid $6,000 so far this year and there's no end in sight to recovering from their brain tumor disaster.
Just read the fine print!
My insurance company's maximum out of pocket policy has two crucial limiting factors:
1. The costs ceiling ONLY refers to services from approved providers.
2. Most important, "thereafter, the plan pays 100 percent for ELIGIBLE charges," my own insurance states.
My insurance recently increased it limits and now has a $4,000 a person or $6,000 per family limit, but that only covers eligible charges and from what I can see, this provision is simply a joke -- a hollow promise that doesn't live up to what it is portrayed as.
From many drugs to some services, the insurance companies do not consider them eligible.
Have a heart attack and you may have a second one when you get the bill for the charges that are not eligible.
Some insurance plans may also have lesser known maximum lifetime benefit provisions.
This is why I believe there needs to be a "truth in health care" law,where insurance companies can't hide behind such almost worthless claims.
The day is here when you simply have to have a lot of money in reserve to handle a health catastrophe, because you aren't really protected by your plan. Sad, but true.
--As a sidelight regarding drugs, my insurance company offers more expensive plans that superficially appear superior -- especially in drug coverage --but when you read the fine print you realize the superior plans also seek to put everyone on generic drugs first anyway, negating their value.

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