Gotcha Moments For New Policy Holders

[scrabble]

I am hoping to compile a list of gotcha moments that can commonly occur to new policy holders and any contributions are appreciated.

For example, I have heard of things like an anesthesiologist being out of network and therefore his services aren't covered.

Anyway, If anyone cares to share their experiences, I would love to hear from you.

Thanks

 

[CHUMPS FROM OXFORD]

Emergency room charges. Many customers (who don't talk to brokers) see a "$100" charge for ER on the policy description pages. They rarely realize that there is also a deductible (in most cases).

 

[Crabcake Johnny]

Ambulance takes someone to the closest hospital since it's an emergency but that hospital's not in network - client gets slammed with bills.

 

[souldeux]

The anesthesiologist thing is a good one. Off the top of my head, there's also:

- The office visit copay covers a history, but not lab work or x-rays

- Generic prescriptions are covered, brand names aren't

- Check the caps (max Rx cap, max outpatient cap, max yearly cap)

- Per-confinement deductibles instead of per-year deductibles

- $250 deductible, $5000 out-of-pocket

- "What do you mean I only had six office visit copays? I'm not paying $500!"

 

[Crabcake Johnny]

In-office lab is a biggie and most agents don't know how their plans handle in-office lab charges.

 

[leftsided]

% of surgery schedules ( reimbursement rates ), client gets billed for remainder all while they thought it was 100%* covered.

 

[Crabcake Johnny]

Air ambulance either not covered or limited. Client gets medivac'ed and slammed with a 10K bill.

 

[CHUMPS FROM OXFORD]

Ambulance takes someone to the closest hospital since it's an emergency but that hospital's not in network - client gets slammed with bills.

I thought that in life-threatening situations...the closest hospital was considered "In-Network."

 

[Crabcake Johnny]

"life-threating" would be the carrier's call, not the doctor or hospital's. Same thing with seeking OON care for a "medical emergency."

 

[CHUMPS FROM OXFORD]

""life-threating" would be the carrier's call, not the doctor or hospital's"


I think I would rather have the doctor or hospital make that call.