Insurance: It’s all about the numbers

Having worked previously for a very large company that some of you might be familiar with … I learned a few things about making sure I chose the right insurance plan for me. There were many options and choices to make. How do you know you are making the right one?

Here is a list of things to consider when chosing an insruance plan:

  1. What services do I use the most?

    A very important factor because those are the benefits that should be taken the most into consideration. So if Acupuncture, Chiropratic care, and massage are major parts of your life, which we hope they are, what does that benefit look like.

  2. Is there a deductible? How much is it? And what does it apply to?

    It’s so interesting because here’s were the game starts. Some plans may cost you less per month but have a higher dedcutible and therefore overall cost you more. Where some plans, paying just a bit more a month will a lower dedcutible will actually save you quite a bit.  You have to do that math …

    Co-worker

    Monthly Payment

    $140 (70 per pay period)

    Deductible

    $3000

    Total Paid

    $4,680 =(140x12) + 3000

    Me

    Monthly Payment

    $180 (90 per pay period)

    Deductible

    $750

    Total Paid

    $2910 =(180x12) + 750

    My co-worker paid a total of $1,770 more a year by the time they paid their monthly insurance and just their deductible. In this case, they also had less visits than I did for acupuncture, chiropractic and massage.

  3. How many visits do I get for alternative health care? Or is it a dollar amount?

    How often you need care and how many times your insruance is willing to pay for are not always the same number. You may want to see us once a week but your insurance will only give you 12 visits which means you would use that benefit up by the end of March and that means the rest of the year is all cash. Other plans have a dollar amount. When it’s a dollar amount, it’s a bit harder to track because the reimburment rate can vary based on what the practioner bills for that day.

  4. Is priod authorization required or a is a medical neccessity review required?

    If this is part of your plan, it means that your insurance company who you pay, will be determining if you need the service you have under that benefit. So it’s a bit of a conflict of interest that the company that you are paying, who is paying for the benefit to the provider is also the one who tells you that you can not get any more care. That being said, it’s a pretty common requirement. You can talk to your HR department about not allowing this to be part of your insurance plan.

  5. What is the cost for medications?

    If you are taking a medication on a regular basis, this is an important factor to consider and keep in mind when crunching the numbers.

  6. What are the costs to go to the ER?

    While we never want you to need to go to the ER, it is always a good idea to know how much it’s going to cost you if you do need to go for a real emergancy. There often is a flat fee that you need to have ready to pay right there when you sign in.

  7. Does my partner get the same plan as me if they are a dependant?

    While we all would assume this is the case, this year, we came across a few plans here at Vitalize that showed two different benefits for people on the same plan. The holder of the plan or the employee had more visits then their spouse who was on the dependant on the plan.

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