It’s perfectly fitting this week that I find myself with a whopper of a cold.
The start of Open Season (sometimes called Open Enrollment) has begun for many Americans. This is the time when one needs to review his/her health insurance for the following year and make changes if needed.
For the last two days, I’ve been sneezing, coughing, blowing, and honking my way through cross-checking our current coverage against what will be different for 2020.
I’m an absolute vision of debonair right now, surrounded by containers of OTC cold medicine, tissue boxes, and a used grocery bag on the floor beside me, into which I am tossing said tissues. Each time I get up to go into the bathroom or kitchen, Gorgeous follows later wearing latex gloves and holding a container of Lysol Wipes. In each of our ways I suppose we’re both doing good deeds, although I suspect hers is slightly tilted more towards self-preservation.
Health insurance plans in the U.S. are required to follow a general uniform format to explain their summary of benefits and the coverage offered. This is a marked improvement from earlier years, when brochures from competing health plan providers all were starkly different from one another. I remember it taking the better part of an hour, often longer, to compare and make sure that everything I needed for coverage was included. Now, thankfully, it usually only takes me about 10-15 minutes to locate the pertinent areas I need to study.
The drill is pretty much what other people are (or should) be doing for the next four weeks or so:
- Review any changes in our current plan. Last year at this time, I discovered that we would be allowed slightly fewer chiropractor visits for 2019. It wasn’t a deal killer thankfully, but it was helpful to at least see the change displayed prominently and in plain language.
- Check and confirm prescription drug coverage. Nearly all the plans have an online search tool making this simple. Three years ago we discovered that a med Gorgeous took would cost at least 40% more on the plan we were then on. It turned out to be the catalyst for switching plans that year.
- Reconfirm that our doctors remain in the plan’s network of providers. This became our big snag this year, which I’ll get into below.
There are other things to check too: the monthly cost of the plan, yearly deductibles, co-pay and co-insurance costs, and the total amount the plan will pay for catastrophic care. I have yet to see a year in which any of these costs stayed the same from the previous year. It’s therefore pretty important to take the time and review everything. Last year our plan actually reduced co-pay costs for one particular coverage, which was a nice surprise.
If you’re reading this right now from, say, Canada, the UK, or Australia, yes, we too find the above routine to be a completely INSANE way to go about getting healthcare. And this is just the preparatory work: at some later point one has to actually navigate the system to see a doctor or <GASP!> a specialist.
Earlier this year a British citizen living here documented his experience about using our healthcare system. He found all the hoops one must jump through to be completely illogical. Coming from a country which has universal healthcare via a single-payer, I can only imagine the man’s utter frustration. The American system of healthcare is similar to going to a restaurant that charges extra for the use of a plate and silverware, while also requiring an advanced reservation for the napkin.
Even after ticking all the boxes ahead of time, there are still huge pot holes over which one must navigate to make sure everything is covered. The good folk at Kaiser Health News document those people who have faced unimaginable nightmares with coverage and billing in their Bill of the Month series. In most cases, these are people who believe they were following all the rules for their insurance plans. Caveat emptor.
Our challenge this year isn’t thankfully with our regular health insurance. We’ll continue to stay on the same Blue Cross plan we were on last year, though it will cost an additional 5% more. This time around, it’s with the optional dental coverage that has me double, triple, and quadruple-checking to make sure everything is tickety boo.
Last June our dentist — whom some of you might recall enjoys the occasional religious tune played overhead while he works — notified us that effective immediately he was no longer participating in-network with our dental insurance provider. He was still happy to serve us, and would even file a claim with them on our behalf, albeit at an immediate out-of-network cost to us. This was disheartening mainly because our dental insurance pays, in the words of my tribe, bupkus for using a non-preferred provider.
I could understand his not wanting to work anymore with our insurance company. That’s a business decision; they probably paid him bupkus, and he was tired of getting a pitiful payment. But he made this monumental decision in the middle of the coverage year. Who does that?! Well, this dentist apparently.
We somehow got through the rest of year by delaying our second regular checkups and cleanings until next year. We could have just gone to another dentist, but we both like this guy in spite of his dubious music choices. When we return to him in January, I do plan on sharing my views about mid-year insurance changes and the effects they have on paying patients.
So along with blowing into Puff’s Plus and sipping hot lemon with honey mixtures, I’ve been doing a little comparative shopping for dental plans over the last few days. The new plan with MetLife does thankfully include our dentist in its network. It also costs 30% more over what we paid this year to the other insurance provider. Caveat emptor indeed.
For those of you who are in the midst of reviewing your own coverage, I wish you well and hope it goes well. For those who can’t be bothered, please at least go to your plan’s website and review any changes to next year’s benefits. And finally, for all you international folk reading this and shaking your heads, I’ll let Elaine Benes have the last word of supportive outrage:
Until next time (cough-cough)…